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INTESTINAL ISCHEMIA (VASCULAR DISORDERS OF INTESTINE)

UNDERSTANDING THE PROBLEM

Intestinal ischemia describes a variety of conditions that occur when blood flow to the intestines decreases due to a blockage, usually in an artery. Intestinal ischemia can affect the small intestine, the large intestine (colon) or both.

Intestinal ischemia is a serious condition that can cause pain and make it difficult for the intestines to work. In severe cases, loss of blood flow to the intestines can damage intestinal tissue and left untreated can be fatal.

UNDERSTANDING WHO SUFFERS

Intestinal ischemia occurs when the blood flow through the major arteries that supply blood to the intestines slows or stops.

Intestinal ischemia is often divided into categories:

  • Colon ischemia (ischemic colitis)
  • Acute mesenteric ischemia

Colon Ischemia

The cause of diminished blood flow to the colon isn't always clear, but a number of conditions that can make a person more vulnerable to colon ischemia:

  • Build-up of cholesterol deposits on the walls of an artery (atherosclerosis)
  • Dangerously low blood pressure (hypotension) associated with heart failure, major surgery, trauma or shock
  • A blood clot in an artery supplying the colon
  • Twisting of the bowel (volvulus) or trapping of intestinal contents within a hernia
  • Excessive bowel enlargement from bowel obstruction caused by scar tissue or a tumor
  • Other medical disorders that affect the blood, such as inflammation of blood vessels (vasculitis), lupus or sickle cell anaemia
  • Some medications, especially those that constrict blood vessels, such as some heart and migraine medications, and hormone medications, such as estrogen
  • Cocaine or methamphetamine use
  • Vigorous exercise, such as long-distance running

Acute mesenteric ischemia

This type of intestinal ischemia usually affects the small intestine. It has an abrupt onset and may be due to:

  • A blood clot (embolus) that dislodges from the heart and travels through the bloodstream to block an artery, usually the superior mesenteric artery, which supplies oxygen-rich blood to the intestines. This is the most common cause of acute mesenteric artery ischemia and can be brought on by congestive heart failure, an irregular heartbeat (arrhythmia) or a heart attack.
  • A blockage that develops within one of the main intestinal arteries and slows or stops blood flow, often as a result of fatty deposits (atherosclerosis) building up on the wall of an artery. This type of sudden ischemia tends to occur in people with chronic intestinal ischemia.
  • Impaired blood flow resulting from low blood pressure due to shock, heart failure, certain medications or chronic kidney failure. This is more common in people who have other serious illnesses and who have some degree of atherosclerosis.

Whatever the cause, diminished blood flow within the digestive tract leaves cells without enough oxygen, which causes the cells to weaken and die. If damage is severe enough, infection, gangrene and eventually a perforation in the wall of the intestines can occur.

POTENTIAL SIGNS AND SYMPTOMS

Signs and symptoms of intestinal ischemia can develop suddenly (acute) or gradually (chronic).

Signs and symptoms of acute intestinal ischemia typically include:

  • Sudden abdominal pain that may range from mild to severe
  • An urgent need to have a bowel movement
  • Frequent, forceful bowel movements
  • Abdominal tenderness or distention
  • Blood in the stool
  • Nausea, vomiting
  • Fever
  • Mental confusion in older adults

Signs and symptoms of chronic intestinal ischemia can include:

  • Abdominal cramps or fullness after eating, usually within the first hour, and lasting one to three hours
  • Abdominal pain that gets progressively worse over weeks or months
  • Fear of eating because of subsequent pain
  • Unintended weight loss
  • Diarrhea
  • Nausea, vomiting
  • Bloating
EXAMINATIONS USUALLY REQUIRED

Several diagnostic tests, based on signs and symptoms, include:

  • Blood tests: Although there are no specific blood markers to indicate intestinal ischemia, laboratory study of a blood sample that shows, say, an increase in white cell count, might suggest intestinal ischemia
  • Imaging tests: Imaging tests may help the doctor see the internal organs and rule out other causes for the signs and symptoms. Imaging tests may include X-ray, ultrasound, CT scan and MRI.
  • Endoscopies of the digestive tract: inserting a lighted, flexible tube with a camera on its tip into the mouth or rectum to view the digestive tract from the inside. The camera can be inserted in the mouth (endoscopy) to help see the upper portion of the small intestine. The camera can also be inserted in the rectum to view the last 2 feet of the colon (sigmoidoscopy) or to view the entire colon (colonoscopy).
  • Using dye to track blood flow through the arteries: During angiography, a long, thin tube (catheter) is inserted into an artery in the groin or arm, then passed through the artery to the aorta. A dye is injected that flows directly to the intestinal arteries. X-ray images are then taken that show the dye moving through the arteries)
  • If intestinal ischemia is the disease, the images may show a blocked or narrowed artery. Angiography also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery.
  • Exploratory surgery: In some cases exploratory surgery may be needed to find and remove damaged tissue. Minimal Invasive exploration of the abdomen allows diagnosis and treatment during one procedure.
PROPOSING TREATMENT AND WHY AIMIS

Treatment of intestinal ischemia involves restoring a sufficient blood supply to the digestive tract. Options vary depending on the cause and severity of the condition.

  • Colon ischemia (antibiotics may be recommended to treat or prevent infections. Colon ischemia may also heal on its own)
  • If the colon has been damaged, surgery may be needed to remove the dead tissue. Surgery may also be needed to bypass a blockage in one of the intestinal arteries.
  • Acute mesenteric artery ischemia
  • Surgery may be necessary to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged section of intestine. Treatment also may include antibiotics and medications to prevent clots from forming, dissolve clots or dilate blood vessels.
  • Chronic mesenteric artery ischemia
  • Treatment involves restoring blood flow to the intestine. Surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty therapy or by placing a stent.
  • Ischemia due to mesenteric venous thrombosis
  • If the intestines show no signs of damage, anticoagulant medication might be taken for about three to six months. If tests show blood-clotting disorder, anticoagulants might be necessary for a lifetime. Anticoagulants help prevent clots from forming. If portions of the bowel show signs of damage, surgery might be needed to remove the damaged section.

A total colectomy involves removing the entire colon. Subtotal colectomy is a term to describe a procedure removing part of the colon. Segmental colectomy is a term describing the removal of a segment of the colon and could also be labelled a hemicolectomy to differentiate between the right or left halves of the large intestine. When using the prefix “procto” it indicates a procedure that involves the removal of the rectum as well as the colon. Rectum removal is called proctectomy. Other terms such as low anterior resection, indicating the removal of the sigmoid colon as well as the upper part of the rectum. Although the rectum is distinct from the colon it is a fact that many pathologic conditions and procedures normally related to the colon will involve the rectum.

If a surgeon recommends surgery to treat Intestinal Ischemia, these are among the potential surgery types for minimally invasive da Vinci Surgery.

AIMIS is an expert in all da Vinci Robotic surgeries related to Diverticulitis and provides advanced techniques offering many advantages over standard laparoscopy such as:

  • Greater precision
  • Lower blood loss
  • Quicker return of bowel function
  • Lower rate of complications
  • Shorter hospital stay
  • Small incisions for minimal scarring

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Complications of intestinal ischemia can include:

  • Death of intestinal tissue: If blood flow to the intestine is completely and suddenly blocked, intestinal tissue can die (gangrene).
  • Perforation: A hole through the wall of the intestines can develop. This results in the contents of the intestine leaking into the abdominal cavity, causing a serious infection (peritonitis).
  • Scarring or narrowing of the colon: Sometimes the intestines can recover from ischemia, but as part of the healing process the body forms scar tissue that narrows or blocks the intestines
  • Intestinal Ischemia can be fatal if left untreated.
FURTHER INFORMATION ON INCREASED RISK GROUPS

Identification of intestinal ischemia often involves a high level of suspicion. Generally, those who are most susceptible are:

  • Individuals older than 50 years of age, particularly those who suffer from diseases such as heart failure and irregularities of cardiac rhythm,
  • Individuals who have had a heart attack or stroke.
  • Various medications used to treat migraine headaches and constrict blood vessels or oral contraceptives also may lead to intestinal ischemia.
  • Individuals predisposed to developing blood clots, also called a venous thrombosis, are more likely to develop intestinal ischemia.
  • This problem can affect young people as well as older individuals and is most often seen in those who have suffered a recent traumatic leg injury and individuals who have been immobile for long periods of time. Others at increased risk for blood clots are those who have a predisposing genetic disorder, IBD, or cancer.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

If a doctor suspect’s intestinal ischemia, several diagnostic tests will be undertaken, based on signs and symptoms and as outline in detail above. In summary these could include:

  • Blood tests
  • Imaging tests. Imaging tests may include X-ray, ultrasound, CT scan and MRI.
  • Using a scope to see inside the digestive tract
  • Using dye to track blood flow through the arteries
  • In intestinal ischemia, the images may show a blocked or narrowed artery.
  • Angiography also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery.
  • Exploratory surgery. In some cases exploratory surgery id one to find and remove damaged tissue.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Lower Gastrointestinal Problems including:

Right & Left Hemicolectomy, Subtotal Colectomy, Total Colectomy, Total Proctocolectomy with pouch, Anterior Resection of the Rectum, Total Mesorectal Excision, Abdominoperineal Excision and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Lower Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Lower blood loss
  • Greater precision
  • Few small incisions - Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • Shorter hospital stays
  • Return to normal activities quicker.

Over the past few years this innovative system has given millions of patients worldwide the benefit of minimal invasive surgery. The da Vinci Xi system has changed technology and the experience of surgery to patients around the world.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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