Intestinal ischemic syndrome

Intestinal ischemic syndrome is caused by visceral artery disease, the narrowing of the arteries that supply blood to the intestines, spleen and liver. The narrowing, in turn, is caused by atherosclerosis, hardening of the arteries due to the build up of plaque or fatty deposits that adhere to the artery wall.

The most common presentation of visceral artery disease is chronic mesenteric ischemia, insufficient blood-flow to the intestines. It causes pain after eating and results in weight loss. It can also result in a fatal interruption of blood-flow to the intestines. Without proper flow, the intestines may begin to die and become gangrenous. This condition requires immediate diagnosis and emergency treatment

Chronic

Gradual narrowing of the affected artery can cause pain in the abdomen after meals. Here are some other symptoms:

• Abdominal pain after eating
• Weight loss
• Avoidance of eating
• Diarrhea, constipation, or vomiting

Acute

If an artery to the intestines becomes acutely blocked, the primary symptom is severe and widespread abdominal pain. Immediate diagnosis and emergency treatment of this life-threatening condition is required.

Additional symptoms may include:

• Frequent vomiting
• Urgent, bloody bowel movements
• Abnormal drop in blood pressure
• High white blood-cell count
• Acidosis, the build up of hydrogen in the blood

The risk factors for visceral artery disease are those associated with atherosclerosis:

• Smoking
• Hypertension (high blood pressure)
• Older age
• Gender — women are more commonly affected
• Family history
• Race or ethnicity
• Genetic factors
• Hyperlipidemia (elevated fats in the blood)
• Diabetes

Patients known to have atherosclerosis and diagnosed with coronary artery disease or peripheral artery disease are at greater risk for visceral artery disease.

Diagnosis of visceral artery disease can be accomplished through duplex ultrasound scanning, a CT scan or contrast angiography.

If a patient’s visceral artery disease is asymptomatic, lifestyle changes and medication may slow the progress of the atherosclerosis. Endovascular and surgical treatments are considered for those experiencing symptoms.

Endovascular treatment

Visceral artery disease may be treated using angioplasty and stenting of the superior mesenteric artery. It involves the placement of a catheter in an artery of the groin through a small puncture in the skin. A balloon is advanced though the affected portion of the artery where it is inflated, dilating the artery wall. A tube-like stent is then inserted to keep the artery open and the blood flowing freely. Patients may stay in the hospital overnight and quickly resume normal activities, but often there is a prolonged period of intestinal dysfunction and recovery may take several weeks or months.

Surgical repair

The surgical options for the treatment of visceral artery disease include:

• Bypass: rerouting of the blood-flow using a graft
• Endarterectomy: surgical removal of the plaque

Open abdominal surgery is required to perform these treatments, a hospital stay of a week or more is required, and recovery can take several weeks or months.