Intestinal Ischemia Surgery & Treatment

Medically reviewed by: Eiman Firoozmand, MD
Last modified on January 17th, 2023

Intestinal ischemia is a condition that affects the blood supply to the intestines. While it’s not as common as hemorrhoids, it can be serious and lead to damage and death of the intestinal tissue.

There are several different types of intestinal ischemia, each with its own set of symptoms and treatment options.

In this article, we will take a look at the different types of intestinal ischemia, their symptoms, and how they are treated.

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What is the treatment for intestinal ischemia?

At a basic level, the goal of treatment for intestinal ischemia is to restore blood flow to the area of the intestine that has been affected. 

Depending on the type, the way your healthcare provider restores this blood supply can vary.

There are 3 main types of intestinal ischemia:

  • Colonic ischemia
  • Acute mesenteric ischemia
  • Chronic mesenteric ischemia

Let’s see how each of these is treated.

What is the treatment for colonic ischemia?

The treatment for mild, non-gangrenous colonic ischemia is supportive and includes things like bowel rest and IV fluids. The treatment for severe gangrenous ischemia is broad-spectrum antibiotics and surgery where the surgeon will remove the affected part of your gut.

As the name suggests, colonic ischemia affects the large intestine (also called the colon). In 95% of the cases, this happens suddenly due to reduced blood flow to the gut. For example, if someone is bleeding heavily, the body will try to restrict the blood flow to the gut to keep vital organs like the brain alive.

In 5% of cases, colonic ischemia occurs due to an obstruction of the blood vessels by a clot.

When the blood supply to the colon is reduced, two things can happen:

  • The patient experiences symptoms, but cells of the colon survive. This is the case in 80% of cases and can be treated with supportive care.
  • The cells of the colon die, which is called gangrene. When this happens, the surgeon has to remove the dead colon. Otherwise, it can burst open and lead to widespread infection in the body, known as sepsis.

What is the treatment for acute mesenteric ischemia?

The treatment for acute mesenteric ischemia begins with supportive care, which includes IV fluids, nasogastric tube placement, and food restriction. A nasogastric tube is a tube that sits in your stomach and removes any excess fluid or food.

Initial treatment also includes broad-spectrum antibiotics and heparin, which is a drug that helps prevent any more clots from forming.

The next step depends on the condition of the patient. Here is how different patients are treated:

  • Patients with stable vital signs (blood pressure, pulse): endovascular revascularization, where the surgeon will put a stent in the affected artery to restore blood flow.
  • Patients with unstable vital signs: emergency surgery to remove the affected part of the gut. These patients are at risk of developing a widespread infection in the body.

Unlike colonic ischemia, the major cause of acute mesenteric ischemia is an occlusion to the blood supply. This is especially true for patients with heart disease, who can develop a clot in the heart that travels to the gut, cutting off its blood supply.

On the other hand, around 20% of acute mesenteric ischemia cases are because of a sudden drop in blood pressure in very ill patients.

What is the treatment for chronic mesenteric ischemia?

The treatment for chronic mesenteric ischemia involves eating frequent but smaller meals and choosing low-fat foods. Patients are also advised to reduce their risk of developing severe gut ischemia by maintaining a healthy lifestyle and quitting smoking.

If these lifestyle changes don’t help with the symptoms, your healthcare provider may recommend a stent placement, just like in the case of acute mesenteric ischemia.

The cause of chronic mesenteric ischemia is different from acute mesenteric ischemia. It’s usually caused by the narrowing of the arteries that supply blood to the gut. This narrowing is caused by fatty deposits in the artery walls, called plaque.

Interestingly, this is the same disease mechanism that causes chest pain (angina) in patients with ischemic heart disease. This is why the treatment for chronic mesenteric ischemia is similar to angina.

What are the symptoms of intestinal ischemia?

The main symptom of intestinal ischemia is abdominal pain. Depending on the type of intestinal ischemia, however, the way this pain presents can differ.

For example, in colonic ischemia, patients experience sudden abdominal pain, usually in the left side of the abdomen (which is also where the pain of diverticulitis occurs). Some people may also get bloody diarrhea within 24 hours of pain.

On the other hand, patients with acute mesenteric ischemia experience severe abdominal pain around the umbilicus, as well as bloody diarrhea.

Finally, chronic mesenteric ischemia patients experience pain in the upper abdomen after eating a meal. That’s because after you eat a meal, your digestive system needs extra blood supply, and if there is a narrowing in the arteries supplying that area, you will feel pain.

As a result of this, chronic mesenteric ischemia patients avoid eating too much, and many suffer from weight loss as a result.

How to diagnose intestinal ischemia?

Healthcare providers diagnose intestinal ischemia by running a series of tests. These include blood work, imaging tests (such as CT scan or MRI), and colonoscopy.

Blood tests help the doctor identify any underlying conditions contributing to your symptoms and rule out infections like C.difficile colitis. Imaging tests provide an image of the arteries supplying blood to your gut.

Finally, a colonoscopy is used to assess the condition of the colon and determine if it can be saved. It’s also used to rule out other causes of bloody diarrhea, such as Crohn’s disease and ulcerative colitis.


Why is lactate elevated in acute intestinal ischemia?

Lactate is a chemical that indicates the level of oxygen in tissues and organs. When there is an insufficient blood supply to an organ, such as the intestines, lactate levels rise in the blood. This is because they are not getting enough oxygen and thus produce more lactate as a way of compensating.

Is intestinal ischemia life-threatening?

Yes, intestinal ischemia can be life-threatening if left untreated. Prompt diagnosis and treatment is important to prevent serious complications such as bowel infarction or perforation.

What type of doctor can treat intestinal ischemia?

Intestinal ischemia is typically treated by a gastroenterologist, colorectal surgeon, vascular surgeon, or interventional radiologist. A team of other medical professionals may also be involved in treating this condition, depending on its severity. For example, if the affected part of the gut needs to be removed, a colorectal surgeon will likely be involved.

How can heart surgery cause intestinal ischemia?

When a patient undergoes cardiac surgery, it can cause a decrease in the blood supply to other parts of the body, including the intestines. This can lead to decreased oxygen levels in the intestines and can result in intestinal ischemia.

Treatment for intestinal ischemia simplified

Intestinal ischemia is a condition in which there is an inadequate blood supply to the intestines. It can be either acute or chronic and can be caused by various factors, such as artery narrowing due to fatty deposits, heart surgery, and blood clots. 

Symptoms vary depending on the type of ischemia but usually include abdominal pain and bloody diarrhea. 

Finally, treatment includes lifestyle changes, medications, and/or surgery. It is important to note that prompt diagnosis and treatment of intestinal ischemia are essential in preventing serious complications. 

Therefore, if you are experiencing abdominal pain and bloody diarrhea, it is important to seek immediate medical attention.

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