Small intestinal ischemia and infarction

Definition

Intestinal ischemia and infarction occurs when there is a narrowing or blockage of one or more of the arteries that supply the small intestine.

Alternative Names

Intestinal necrosis; Ischemic bowel - small intestine; Dead bowel - small intestine; Dead gut - small intestine; Infarcted bowel - small intestine; Atherosclerosis - small intestine; Hardening of the arteries - small intestine

Causes

There are several possible causes of intestinal ischemia and infarction.

Symptoms

The main symptom of intestinal ischemia is pain in abdomen. The pain is severe, even though the area is not very tender when touched. Other symptoms include:

Exams and Tests

Laboratory tests may show a high white blood cell (WBC) count (a marker of infection). There may be bleeding in the GI tract.

Some tests to detect the extent of damage include:

These tests do not always detect the problem. Sometimes, the only way to detect intestinal ischemia is with a surgical procedure.

Treatment

In most cases, the condition needs to be treated with surgery. The section of intestine that has died is removed. The healthy remaining ends of the bowel are reconnected.

In some cases, a colostomy or ileostomy is needed. The blockage of arteries to the intestine is corrected, if possible.

Outlook (Prognosis)

Damage or death of the bowel tissue is a serious condition. This can result in death if not treated right away. The outlook depends on the cause. Prompt treatment can lead to a good outcome.

Possible Complications

Damage or death of the bowel tissue may require a colostomy or ileostomy. This may be short-term or permanent. Peritonitis is common in these cases. People who have a large amount of tissue death in the intestine can have problems absorbing nutrients. They can become dependent on getting nutrition through their veins.

Some people may become severely ill with fever and a bloodstream infection (sepsis).

When to Contact a Medical Professional

Contact your health care provider if you have any severe abdominal pain.

Prevention

Preventive measures include:

References

Feuerstadt P, Brandt LJ. Intestinal ischemia. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 118.

Holscher CM, Reifsnyder T. Acute mesenteric ischemia. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1057-1061.

Kahi CJ. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 134.

Roline CE, Reardon RF. Disorders of the small intestine. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 82.


Review Date: 2/7/2022
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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