Intestinal infarction usually affects elderly individuals, with an average age of occurrence in the 6th-7th decade of life. Although symptomatology directs the physician towards a severe pathology, the symptoms elicited are not specific for intestinal infarction.

The predominant and profound symptom reported by the vast majority of the patients (94%) is that of intense and constant abdominal pain disproportionate in severity in comparison to the objective findings on a physical exam [1]. Additional symptoms that complete the clinical picture also include nausea, episodes of diarrhea, tachycardia, and vomiting. In a more advanced stage, the ischemic occurrence leads to necrosis of the intestine, sepsis, and peritonitis; symptoms also include hypotension, a distended, painful abdomen, rigidity and guarding [2] [3] [4] [5]. Progression of the ischemia is transmural [6].

A detailed medical history is certainly the first step towards reaching a diagnosis of intestinal infarction. Intense, persistent pain disproportionate in severity compared to the physical exam is the hallmark of the condition. Nausea, tachycardia, vomiting and diarrhea may complete the clinical picture; signs of peritoneal irritation may also be present if intestinal infarction has already been complicated by gangrenous peritonitis. Peritoneal signs also include abdominal rigidity, a positive rebound sign, hypotension, guarding and a considerable distention in the abdomen.

With regard to laboratory findings, most patients display the following, although recent studies have shown that none of them can be relied upon for a definitive diagnosis [7]:

• Leucocytosis [6]: white cell blood count typically amounts to over 20 x 109/L in the serum. This finding is solely used as an inflammation indicator since it is exhibited in the vast majority of inflammatory processes [8] [9].
• Acid-base imbalance [10]: although patients are expected to exhibit metabolic acidosis, metabolic alkalosis is sometimes diagnosed, due to vomiting during the initial stages of the disease.
• Increased D-dimer serum levels, which also cannot be considered pathognomonic for intestinal infarction [11].
• Increased L-lactate levels

An extremely valuable tool for the definitive diagnosis of intestinal infarction is mesenteric angiography, due to its indisputable accuracy, efficacy and potential to increase the survival rate it is considered as a gold standard [12] [13]. Currently, another imaging modality, computed tomography angiography (CTA) has effectively replaced mesenteric angiography in the diagnosis of intestinal infarction, as it is less invasive and has a specificity and sensitivity of 94% and 96% respectively [14] [15].

The primary goal of treatment is to restore blood flow to the affected area of the intestine. This may involve surgical intervention to remove any blockages or dead tissue. In some cases, medications to dissolve clots or improve blood flow may be used. Supportive care, including fluids, pain management, and antibiotics, is also essential to stabilize the patient and prevent complications.

The prognosis for intestinal infarction depends on the speed of diagnosis and treatment. Early intervention can significantly improve outcomes, while delays can lead to complications such as sepsis or multi-organ failure. Mortality rates remain high, especially in cases where treatment is delayed or if the patient has underlying health issues.

Intestinal infarction is primarily caused by a reduction in blood flow to the intestines. This can occur due to an embolism (a blood clot that travels to the intestine), thrombosis (a clot that forms in the blood vessels), or non-occlusive mesenteric ischemia (reduced blood flow without a blockage, often due to low blood pressure). Risk factors include cardiovascular diseases, recent heart attacks, and certain medications.

Intestinal infarction is relatively rare but is more common in older adults and those with pre-existing cardiovascular conditions. It accounts for a small percentage of acute abdominal emergencies but has a high mortality rate. The incidence is higher in populations with a high prevalence of risk factors such as atrial fibrillation and atherosclerosis.

The pathophysiology of intestinal infarction involves the interruption of blood flow to the intestines, leading to ischemia (lack of oxygen) and subsequent tissue death. This process triggers an inflammatory response, causing further damage to the intestinal wall. If untreated, the dead tissue can lead to perforation, peritonitis (inflammation of the abdominal lining), and systemic infection.

Preventing intestinal infarction involves managing risk factors and underlying conditions. This includes controlling cardiovascular diseases, managing blood pressure, and using anticoagulant medications in patients at risk of blood clots. Lifestyle modifications such as a healthy diet, regular exercise, and smoking cessation can also reduce risk.

Intestinal infarction is a critical condition characterized by the loss of blood supply to the intestines, leading to tissue death. Prompt diagnosis and treatment are essential to improve outcomes. Understanding the risk factors, symptoms, and treatment options can aid in early detection and management, potentially saving lives.

For patients, understanding intestinal infarction involves recognizing the symptoms of severe abdominal pain, nausea, and changes in bowel habits. It is important to seek medical attention immediately if these symptoms occur, especially if you have risk factors like heart disease. Treatment often involves surgery and supportive care, and early intervention is crucial for a better prognosis. Managing underlying health conditions and maintaining a healthy lifestyle can help reduce the risk of developing this condition.

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