Ischemic Colitis

ABSTRACT

Ischemic colitis is the most common form of gastrointestinal ischemia. Patients present with either occlusive or nonocclusive vascular disease, although the latter is more common. Many causes of nonocclusive disease have been identified, but the exact pathophysiology remains unclear. Most commonly, patients develop abdominal discomfort and bloody diarrhea. Diagnosis is confirmed with colonoscopy. Treatment is contingent on the severity of disease: mucosal/nongangrenous ischemia requires only supportive measures and medical management, whereas transmural/gangrenous ischemia may require prompt surgical intervention. Ischemic colitis can also become a chronic process with persistent segmental colitis or colonic stricturing. The patient's outcome depends on the severity of disease, prompt recognition, and appropriate treatment.

Ischemic colitis - colonoscopy - gastrointestinal bleeding - colectomy - proctosigmoiditis

REFERENCES

• 1 Brandt L J, Boley S J. Colonic ischemia.  Surg Clin North Am. 1992;  72 203-229
• 2 Shaw R S, Green T H. Massive mesenteric infarction following inferior mesenteric-artery ligation in resection of the colon for carcinoma.  N Engl J Med. 1953;  248 890-891
• 3 Smith R F, Szilagyi D E. Ischemia of the colon as a complication in the surgery of the abdominal aorta.  Arch Surg. 1960;  80 806-821
• 4 Boley S J, Schwartz S, Lash J, Sternhill V. Reversible vascular occlusion of the colon.  Surg Gynecol Obstet. 1963;  116 53-60
• 5 Boley S J, Krieger H, Schultz L et al.. Experimental aspects of peripheral vascular occlusions of the intestine.  Surg Gynecol Obstet. 1965;  121 789-794
• 6 Marston A, Pheils M T, Thomas M L, Morson B C. Ischemic colitis.  Gut. 1966;  7 1-15
• 7 Gandhi S K, Hanson M M, Vernava A M, Kaminski D L, Longo W E. Ischemic colitis.  Dis Colon Rectum. 1996;  39 88-100
• 8 Michels N A, Siddharth P, Kornblith P L, Parke W W. The variant blood supply to the descending, rectosigmoid, and rectum based on 400 dissections. Its importance in regional resections: a review of the literature.  Dis Colon Rectum. 1965;  8 251-278
• 9 Griffiths J D. Surgical anatomy of the blood supply of the distal colon.  Ann R Coll Surg Engl. 1956;  19 241-256
• 10 Macdonald P H. Ischaemic colitis.  Best Pract Res Clin Gastroenterol. 2002;  16 51-61
• 11 Bower T C. Ischemic colitis.  Surg Clin North Am. 1993;  73 1037-1053
• 12 Geber W F. Quantitative measurements of blood flow in various areas of the small and large bowel.  Am J Physiol. 1960;  198 985-986
• 13 Gilsdorf R B, Urdenata L F, Leonard A S et al.. Posterior hypothalamic effect on gastrointestinal blood flow in the conscious cat.  Proc Soc Exp Biol Med. 1973;  143 329-334
• 14 Murray M J, Gonze M D, Nowak L R, Cobb C F. Serum d-lactate levels as an aid to diagnosing acute intestinal ischemia.  Am J Surg. 1994;  167 575-578
• 15 Poeze M, Froon A HM, Greve J WM, Ramsay G. d-Lactate as an early marker of intestinal ischemia after ruptured abdominal aortic aneurysm repair.  Br J Surg. 1998;  85 1221-1224
• 16 Wolf E L, Sprayregen S, Bakel C W et al.. Radiology in intestinal ischemia: plain film contrast, and other imaging studies.  Surg Clin North Am. 1992;  72 107-124
• 17 Balthazar E J, Yen B C, Gordon R B. Ischemic colitis: CT evaluation of 54 cases.  Radiology. 1999;  211 381-388
• 18 Teefey S A, Roarke M C, Brink J A et al.. Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US.  Radiology. 1996;  198 547-551
• 19 Scherpenisse J, van Hees P AM. The endoscopic spectrum of colonic mucosal injury following aortic aneurysm resection.  Endoscopy. 1989;  21 174-176
• 20 Brandt L J, Boley S J, Sammartano R J. Carbon dioxide and room air insufflation of the colon: effects on colonic blood flow and intraluminal pressure in the dog.  Gastrointest Endosc. 1986;  32 324-329
• 21 Path E J, McClure J N. Intestinal obstruction: protective action of sulfasuxidine and sulfathalidine to ileum following vascular damage.  Ann Surg. 1950;  131 159-163
• 22 Sarnoff S J, Fine J. Effect of chemotherapy on ileum subjected to vascular injury.  Ann Surg. 1945;  121 74-78
• 23 Fitzgerald S F, Kaminski D L. Ischemic colitis.  Semin Colon Rectal Surg. 1993;  4 222-228
• 24 Scharff J R, Longo W E, Vartanian S M et al.. Ischemic colitis: spectrum of disease and outcome.  Surgery. 2003;  134 624-630
• 25 Cappell M S. Intestinal (mesenteric) vasculopathy III. Ischemic colitis and chronic mesenteric ischemia.  Gastroenterol Clin North Am. 1998;  27 827-860
• 26 Zelenock G B, Stordel W E, Knol J A et al.. A prospective study of clinically and endoscopically documented colonic ischemia in 100 patients undergoing aortic reconstructive and aggressive colonic and direct pelvic revascularization, compared with historic controls.  Surgery. 1989;  106 771-779
• 27 Hagihara P F, Ernst C B, Griffen W B. Incidence of ischemic colitis following abdominal aortic reconstruction.  Surg Gynecol Obstet. 1979;  149 571-573
• 28 Brewster D C, Franklin D P, Cambria R P et al.. Intestinal ischemia complicating abdominal aortic surgery.  Surgery. 1991;  109 447-454
• 29 Welling R E, Roedersheimer L R, Arbaugh J J, Cranley J J. Ischemic colitis following repair of ruptured abdominal aortic aneurysm.  Arch Surg. 1985;  120 1368-1370
• 30 Maupin G E, Rimar S D, Villalba M. Ischemic colitis following abdominal aortic reconstruction for ruptured aneurysm: a 10-year experience.  Am Surg. 1989;  55 378-380
• 31 Valentine J R, Hagino R T, Jackson M R et al.. Gastrointestinal complications after aortic surgery.  J Vasc Surg. 1998;  28 404-411
• 32 Bjorck M, Troeng T, Bergqvist D. Risk factors for intestinal ischaemia after aortoiliac surgery: a combined cohort and case-control study of 2824 operations.  Eur J Vasc Endovasc Surg. 1997;  13 531-539
• 33 Amundsen S, Trippestad A, Viste A, Soreide O. Abdominal aortic aneurysms-a national multicentre study.  Eur J Vasc Surg. 1987;  1 239-243
• 34 Bergman R T, Gloviczki P, Welch T J et al.. Role of intravenous fluorescein in detection of colon ischemia during aortic reconstruction.  Ann Vasc Surg. 1992;  6 74-79
• 35 Kuo W T, Lee D E, Saad W EA et al.. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage.  J Vasc Interv Radiol. 2003;  14 1503-1509
• 36 Bharucha A E, Tremaine W J, Johnson C D, Batts K P. Ischemic proctosigmoiditis.  Am J Gastroenterol. 1996;  91 2305-2309