In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve.Acute intestinal ischemia affects about five per hundred thousand people per year in the developed world. Chronic intestinal ischemia affects about one per hundred thousand people. Most people affected are over 60 years old. Rates are about equal in males and females of the same age. Intestinal ischemia was first described in 1895. Signs and symptoms
While not always present and often overlapping, three progressive phases of intestinal ischemia have been described:
A hyper active stage occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase. A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam. Finally, a shock phase can develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.
Blood tests
In a series of 58 patients with intestinal ischemia due to mixed causes:
White blood cell count >10.5 in 98% (probably an overestimate as only tested in 81% of patients)
Lactic acid elevated 91% (probably an overestimate as only tested in 57% of patients)In very early or very extensive acute intestinal ischemia, elevated lactate and white blood cell count may not yet be present. In extensive mesenteric ischemia, bowel may be ischemic but separated from the blood flow such that the byproducts of ischemia are not yet circulating. During endoscopy
A number of devices have been used to assess the sufficiency of oxygen delivery to the colon. The earliest devices were based on tonometry, and required time to equilibrate and estimate the pHi, roughly an estimate of local CO2 levels. The first device approved by the U.S. FDA (in 2004) used visible light spectroscopy to analyze capillary oxygen levels. Use during aortic aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. In several studies, specificity has been 83% for chronic intestinal ischemia and 90% or higher for acute colonic ischemia, with a sensitivity of 71%-92%. This device must be placed using endoscopy, however.Findings on gastroscopy may include edematous gastric mucosa, and hyperperistalsis.Finding on colonoscopy may include: fragile mucosa, segmental erythema, longitudinal ulcer, and loss of haustrations

Plain X-ray
Plain X-rays are often normal or show non-specific findings. Computed tomography
Computed tomography (CT scan) is often used.