Ischemic Colitis: A Clinical Review

Bryan T. Green, MD; David A. Tendler, MD

Disclosures

South Med J. 2005;98(2):217-222. 

In This Article

Abstract and Introduction

Abstract

Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.

Introduction

Ischemic colitis is the most common form of intestinal ischemia, and accounts for 1 in 1,000 hospitalizations.[1] Although frequent in the elderly, younger patients may also be affected. Clinically, it manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa, carrying a good prognosis, to acute fulminant ischemia with transmural infarction, which may progress to necrosis and death. Colon ischemia was first described as caused by ligation of the inferior mesenteric artery during aortic reconstruction or colon resection but is now recognized to have many potential causes.[2,3] The diverse causes, variable clinical presentations, and severity makes the diagnosis and management of ischemic colitis a challenge.

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