Colonic ischemia

Alternative names

Ischemic colitis

Definition

Ischemic colitis involves an area of inflammation (irritation and swelling) caused by interference with the blood flow to the large intestine.

Causes, incidence, and risk factors

Interference with blood flow to the colon is the cause of ischemic colitis. The disorder mainly affects people over 50, many of whom have a history of peripheral vascular disease. Other risk factors include:

• Previous aortic surgery with inadvertent damage to the artery supplying the colon
  
• History of stroke
  
• Low blood pressure
  
• Congestive heart failure
  
• Diabetes
  
• Abdominal radiation exposure
  

Symptoms

• Abdominal pain
  
• Fever
  
• Vomiting
  
• Bright red blood via the rectum (blood in the stool)
  
• Diarrhea
  

Signs and tests

• Colonoscopy or flexible sigmoidoscopy showing inflamed mucosa or ulcers in the colon
  
• Angiography showing a vascular (blood vessel) lesion
  

Treatment
Mild, transient ischemic colitis is treated by maintaining good blood pressure. This can be done with medicines and avoiding dehydration. Antibiotics are sometimes used.

Chronic ischemic colitis leading to stricture formation is treated by surgical removal of the stricture.

Severe ischemic colitis leading to gangrene is treated with replacement of blood volume, antibiotics, and surgical removal of the affected bowel area.

Expectations (prognosis)

Most cases of ischemic colitis are mild, self-limited, and do not require therapy. The death rate is high when gangrene occurs as a result of inadequate blood supply.

Complications

• Gangrene of the bowel
  
• Perforation (hole in the intestine)
  
• Peritonitis (inflammation of the lining of the abdomen)
  
• Sepsis