Acute Intestinal Ischemia in Adults: Evidence-Based Emergency Imaging

  • Lisa P. LavelleEmail author
  • Sinead H. McEvoy
  • Anne G. Carroll
  • Richard G. Kavanagh
  • Jeffrey W. McCann
  • Dermot E. Malone
  • Michael Cline
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


Acute intestinal ischemia is defined as inadequate blood supply to the gut. It has a high mortality rate, ranging between 32% and 93% depending on etiology. Acute intestinal ischemia may be caused by arterial or venous occlusion or by nonocclusive hypoperfusion states. The incidence increases with age and the majority of patients are over the age of 60. A high index of clinical suspicion is necessary for early detection and treatment of acute intestinal ischemia as signs, symptoms, and laboratory tests for intestinal ischemia are nonspecific. Multidetector computed tomography angiography is highly sensitive and specific in detecting small bowel ischemia and may be used as a first-line imaging method. In patients for whom contrast-enhanced computed tomography is contraindicated, abdominal radiographs are of little value in the diagnosis of intestinal ischemia; however, ultrasound and magnetic resonance angiography may be used as alternative imaging modalities. While surgery is the mainstay of treatment of acute intestinal ischemia, endovascular revascularization can be considered in patients without clinical evidence of peritonitis but with radiological evidence of advanced ischemia and recent onset of symptoms and with a low threshold for converting to open surgery if required.


Intestinal ischemia Computed tomography Ultrasound Magnetic resonance imaging Endovascular Evidence-based imaging Emergency imaging 


  1. 1.
    Acosta S, Ogren M, Sternby NH, et al. Eur J Vasc Endovasc Surg. 2004;27(2):145–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Schoots IG, Koffeman GI, Legemate DA, et al. Br J Surg. 2004;91(1):17–27.CrossRefPubMedGoogle Scholar
  3. 3.
    Bartone G, Severino BU, Armellino MF, et al. Radiol Clin N Am. 2008;46(5):887–9. vCrossRefPubMedGoogle Scholar
  4. 4.
    Sreenarasimhaiah J. BMJ. 2003;326(7403):1372–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rhee RY, Gloviczki P, Mendonca CT, et al. J Vasc Surg. 1994;20(5):688–97.CrossRefPubMedGoogle Scholar
  6. 6.
    Paterno F, Longo WE. Radiol Clin N Am. 2008;46(5):877–85. vCrossRefPubMedGoogle Scholar
  7. 7.
    Gore RM, Yaghmai V, Thakrar KH, et al. Radiol Clin N Am. 2008;46(5):845–75. vCrossRefPubMedGoogle Scholar
  8. 8.
    Wiesner W, Khurana B, Ji H, et al. Radiology. 2003;226(3):635–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Landow L, Andersen LW. Acta Anaesthesiol Scand. 1994;38(7):626–39.CrossRefPubMedGoogle Scholar
  10. 10.
    Romano S, Niola R, Maglione F, et al. Radiol Clin N Am. 2008;46(5):891–908. viCrossRefPubMedGoogle Scholar
  11. 11.
    Moschetta M, Telegrafo M, Rella L, et al. World J Radiol. 2014;6(5):130–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Horton KM, Fishman EK. Radiographics. 2001;21(6):1463–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Ho LM, Paulson EK, Thompson WM. AJR Am J Roentgenol. 2007;188(6):1604–13.CrossRefPubMedGoogle Scholar
  14. 14.
  15. 15.
    Whiting PF, Weswood ME, Rutjes AW, et al. BMC Med Res Methodol. 2006;6:9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Akyildiz H, Akcan A, Ozturk A, et al. Am J Surg. 2009;197(4):429–33.CrossRefPubMedGoogle Scholar
  17. 17.
    Aschoff AJ, Stuber G, Becker BW, et al. Abdom Imaging. 2009;34(3):345–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Kirkpatrick ID, Kroeker MA, Greenberg HM. Radiology. 2003;229(1):91–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Ofer A, Abadi S, Nitecki S, et al. Eur Radiol. 2009;19(1):24–30.CrossRefPubMedGoogle Scholar
  20. 20.
    Wiesner W, Hauser A, Steinbrich W. Eur Radiol. 2004;14(12):2347–56.CrossRefPubMedGoogle Scholar
  21. 21.
    Zandrino F, Musante F, Gallesio I, et al. Minerva Gastroenterol Dietol. 2006;52(3):317–25.PubMedGoogle Scholar
  22. 22.
    Cudnik MT, Darbha S, Jones J, et al. Acad Emerg Med Off J Soc Acad Emerg Med. 2013;20(11):1087–100.CrossRefGoogle Scholar
  23. 23.
    Menke J. Radiology. 2010;256(1):93–101.CrossRefPubMedGoogle Scholar
  24. 24.
    Barmase M, Kang M, Wig J, et al. Eur J Radiol. 2011;80(3):e582–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Blachar A, Barnes S, Adam SZ, et al. Emerg Radiol. 2011;18(5):385–94.CrossRefPubMedGoogle Scholar
  26. 26.
    Yikilmaz A, Karahan OI, Senol S, et al. Eur J Radiol. 2011;80(2):297–302.CrossRefPubMedGoogle Scholar
  27. 27.
    Oliva IB, Davarpanah AH, Rybicki FJ, et al. Abdom Imaging. 2013;38(4):714–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Wyers MC. Semin Vasc Surg. 2010;23(1):9–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Acosta S, Bjorck M. Br J Surg. 2014;101(1):e100–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, et al. J Vasc Surg. 2014;59(1):159–64.CrossRefPubMedGoogle Scholar
  31. 31.
    Bjornsson S, Resch T, Acosta S. J Gastrointest Surg. 2013;17(5):973–80.CrossRefPubMedGoogle Scholar
  32. 32.
    Arthurs ZM, Titus J, Bannazadeh M, et al. J Vasc Surg. 2011;53(3):698–704. discussion 5CrossRefPubMedGoogle Scholar
  33. 33.
    Jia Z, Jiang G, Tian F, et al. Eur J Vasc Endovasc Surg. 2014;47(2):196–203.CrossRefPubMedGoogle Scholar
  34. 34.
    Karkkainen JM, Lehtimaki TT, Saari P, et al. Cardiovasc Intervent Radiol. 2015;38(5):1119–29.CrossRefPubMedGoogle Scholar
  35. 35.
    Brandt LJ, Boley SJ. Gastroenterology. 2000 May;118(5):954–68.CrossRefPubMedGoogle Scholar
  36. 36.
    ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA) Res. 36–2011, Amended 2014 (Res. 39).Google Scholar
  37. 37.
    Bae KT, Heiken JP. Eur Radiol. 2005;15(Suppl 5):E46–59.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lisa P. Lavelle
    • 1
    Email author
  • Sinead H. McEvoy
    • 1
  • Anne G. Carroll
    • 1
  • Richard G. Kavanagh
    • 1
  • Jeffrey W. McCann
    • 1
  • Dermot E. Malone
    • 1
  • Michael Cline
    • 2
  1. 1.Department of RadiologySt. Vincent’s University HospitalDublinIreland
  2. 2.Department of RadiologyInterventional Radiology Resident, Michigan MedicineAnn ArborUSA

Personalised recommendations