Early diagnosis and prompt treatment are essential to improve your chances for a good-outcome. The longer you go without treatment, the higher the chance of irreversible damage to the small bowel and, in an acute case, death.
Your doctor will begin with a thorough evaluation that includes:
- Medical history: Your doctor will ask you about symptoms you are experiencing and discuss possible risk factors such as atherosclerosis.
- Physical exam: The doctor will examine you for abdominal pain, tenderness, or other signs.
- Lab tests: There is no specific blood test for small bowel ischemia, but a blood test can check for high white blood cell counts, a sign of inflammation or infection. Your doctor may also test your stool for blood.
Other tests your doctor may order include:
Imaging tests for small bowel ischemia
Your doctor can view your intestines and internal organs to check for narrowed or blocked arteries or veins. Imaging can also help rule out other causes that have similar symptoms.
For some imaging tests, you lie on a table while a technician uses sophisticated equipment to take detailed images of your abdomen and pelvis. Other tests involve inserting a thin tube into your artery to view the inside of your body and the blood vessels within your body more clearly. Your doctor will make sure you are comfortable and provide a sedative or anesthesia as necessary, depending on your procedure.
Possible tests include:
- CT scan: This imaging test uses special X-ray equipment to take cross-sectional images of your abdomen and pelvis, which are compiled into 3D images of the intestines.
- MRI scan: A large magnet and radio waves produce images of the intestines and other abdominal organs.
- Angiogram: The doctor inserts a catheter (a long, thin tube) into an artery in your groin and carefully guides it to the largest central blood vessel in your body (e.g., the aorta) to inject a dye. The dye flows into the arteries supplying blood to the small and large bowel, and then a technician takes X-rays to show blood flow. In many cases, the doctor can treat artery blockages during the same procedure (known as angioplasty) with or without placing a stent to provide a more permanent treatment.
- CT angiogram: This test uses a CT scan and appropriate timing of contrast injection into your blood vessels to view the dye in your intestinal arteries and clarify whether there are blockages.
Exploratory surgery to diagnose small bowel ischemia
If other tests don’t provide enough information for a definitive diagnosis, you may need exploratory surgery. Surgery enables doctors to diagnose and treat during the same procedure.
Gastrointestinal surgeons perform minimally invasive or open surgery. The goal is to find and either remove or bypass blockages in the blood vessels. Surgeons can also locate and remove diseased or dead tissue in the small intestine. If the surgeon needs to remove sections of intestine, the remaining healthy sections are frequently reconnected so the digestive system can continue to function. If this is not possible during the acute surgery, then a portion of bowel is brought through the skin as an outlet (also called an “ostomy”) where the contents of the bowel drain through this site and a bag on the skin outside the body covering this outlet will collect the contents of the digestive tract. If an ostomy is needed, this can frequently be reversed several months after the original surgery during a second surgical procedure where the bowel is re-attached to one another and an ostomy is no longer present.