Gangrenous Bowel

Gangrenous bowel is a life-threatening condition in which parts of the intestine (also called the bowel) lose their blood supply and die. Cells in the body depend on a constant source of oxygen and nutrients in the blood. When they lose that supply, they cannot survive. Immediate treatment is needed, usually emergency surgery. Otherwise, gangrene can lead to serious complications and death.

Gangrene can occur in the large intestine (colon) and small intestine. Gangrenous bowel occurs most often in people older than 50. In adults, it usually is the result of ischemic bowel disease. "Ischemic" refers to poor or no blood circulation and has a variety of causes. If the condition continues to get worse, gangrenous bowel can develop.

Gangrenous bowel also can occur in infants and young children who have a bowel obstruction or twisting.

CAUSES

Common causes of ischemic bowel disease that results in gangrene include:

  • Strangulated hernia. This is a twisted intestinal bulge in the abdomen. It blocks blood flow and causes tissue to die.

  • Twisting in any part of the intestine.

  • Blood clots.

  • Cardiovascular disease, which involves the heart and the blood vessels connected to it.

  • Tumors.

In children with gangrenous bowel, the cause is usually:

  • An obstruction in the intestine.

  • Twisting in any part of the intestine.

SYMPTOMS

Gangrenous bowel symptoms include:

  • Intense pain in the abdomen.

  • Fever.

  • Vomiting.

Symptoms of ischemic bowel disease, which can lead to gangrenous bowel, include:

  • Persistent abdominal pain.

  • Blood in the stool.

  • Diarrhea.

  • Frequent urge to have a bowel movement.

  • Nausea or vomiting.

DIAGNOSIS

Gangrenous bowel requires urgent treatment. Because of this, a caregiver might not do many tests. Instead, the patient may be rushed into emergency surgery.

If there is time, though, a caregiver can use various tests to get a precise diagnosis. Tests can also indicate the extent of the problem. Tests that could be helpful include:

  • Blood tests.

  • X-rays.

  • Computed tomography (CT scan). This combines X-ray and computer technology to create an image of the intestine.

  • Magnetic resonance angiogram (MRA). This uses radio waves and magnetic fields to check blood flow to the bowel.

TREATMENT

  • Emergency resection (removal) of the gangrenous tissue is the main treatment for gangrenous bowel.

  • Antibiotics may be given both before and after surgery.

In some cases, a new opening in the abdomen must be created so that waste material can empty into a bag placed on the outside of the body. This surgery is called a colostomy if the remaining part of the colon is rerouted to this opening. It is called an ileostomy if the ileum (the last part of the small intestine) is rerouted.

HOME CARE INSTRUCTIONS

Normal precautions should be taken after surgery. The patient:

  • May need more sleep or notice a change in sleep patterns. This is normal.

  • Should avoid strenuous exercise. Do not lift, carry, pull or move heavy objects (more than 5 pounds [2.27 Kgs]) until the surgeon says it is safe.

  • Should keep the area around the incision dry until the stitches or staples are removed. Avoid tub baths.

  • May notice a small amount of clear, yellow or reddish-yellow fluid draining from the incision for a few days after surgery. This is normal.

  • May experience cramping, abdominal pain and bloating. These symptoms should improve as days go by. Eating small, frequent meals might help.

  • Should drink fluids to stay hydrated. (Urine should be a light yellow color.) Do not drink alcohol while recovering from surgery.

Patients who have had a colostomy or ileostomy will also have to learn to care for the opening (called a stoma) and the bag, sometimes called an appliance. Ask your caregiver for specific instructions.

SEEK MEDICAL CARE IF:

  • Pain or discomfort in the abdomen does not decrease after several days.

  • Watery diarrhea does not improve.

  • Food and drink cause stomach or intestinal upset or pain.

SEEK IMMEDIATE MEDICAL CARE IF:

  • A thick, foul-smelling substance is draining from the incision. This is a warning sign of infection.

  • Redness develops around the incision. This could signal an infection.

  • The patient has persistent vomiting or severe pain anywhere in the body.

  • A fever of 101° F (38.3° C) or higher is recorded.