Ischemic Colitis

Huet, Raul; Jacobson, Eugene D.

doi:10.1159/000171176

Cited by 6 publications

(5 citation statements)

References 41 publications

(64 reference statements)

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“…The causes of colonic ischemia are diverse, and a spectrum of changes from transient colitis to gangrene is seen. 13,14,17,18 The pattern of injury in the case under discussion is consistent with hypoperfusion of the colon. No thrombi, emboli, atherosclerosis, vasculitis, or other vascular changes were identified.…”

Section: P Athological Discussionmentioning

confidence: 56%

“…The changes were consistent with the diagnosis of ischemic colitis. 9,[12][13][14] The absence of an intense inflammatory infiltrate, fissures, transmural inflammation, and granulo- mas ruled out Crohn's disease or ulcerative colitis as a cause of the colitis. 15 No volcano-like lesions, which are typical of pseudomembranous colitis, were seen.…”

Section: P Athological Discussionmentioning

confidence: 99%

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Case 9-1995

Moncure¹,

Rashid²

1995

N Engl J Med

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A 60-year-old man was admitted to the hospital because of left-sided abdominal pain and diarrhea.The patient had been in stable health until three or four years earlier, when he began to have intermittent pain in the left flank that radiated to the left upper and lower quadrants, without a change in bowel habit. Evaluation included a colonoscopic examination, an intravenous urographic study, and a computed tomographic (CT) scan of the abdomen, which were negative. Three months before admission severe, diffuse abdominal pain occurred, and the patient was seen at another hospital. He passed fresh blood through the rectum frequently for the first 12 hours. Proctosigmoidoscopic examination was negative, and stool cultures yielded no pathogenic microorganisms. The patient was discharged after four days without a definitive diagnosis.Two months before admission colonoscopic examination at this hospital was negative. The patient was subsequently well except for bouts of minor pain in the left flank. Sixteen days before admission severe pain recurred on the left side of the abdomen and in the left flank. He was admitted to a second hospital, where his temperature rose to 39.2ºC, with evidence of peritoneal irritation. At laparotomy a thickened mesentery of the splenic flexure was observed; an intraoperative colonoscopic examination revealed ulcers in the same area. The splenic flexure was resected, and a temporary transverse colostomy was performed. Microscopical examination of the specimen obtained during the operation showed changes consistent with ischemic colitis. The postoperative course was prolonged by persistent fever, for which antibiotics were given, and he was discharged on the 13th hospital day.Two days before admission similar abdominal and left-flank pain recurred and worsened progressively. On the next day the patient passed several hard lumps of stool from the colostomy, followed by diarrheal stools, and late that evening he came to this hospital.The patient was an educator. He had never smoked, consumed little alcohol, and used no illicit drugs. An appendectomy had been performed many years earlier, and several bouts of pyelonephritis occurred before the age of 43 years, with negative evaluations of the urinary tract. He had undergone surgery for a hiatus hernia and the carpal tunnel syndrome. Idiopathic hypertrophic subaortic stenosis was discovered 12 years before admission, and a myomectomy was performed, with incomplete relief of symptoms. Eight years before admission the patient was treated for acute renal failure, which was ascribed to rhabdomyolysis of uncertain cause. Eight months before admission a dual-chamber electronic pacemaker was implanted for pacing from the right ventricular apex; he had no atrioventricular dissociation or other cardiac arrhythmias. His medications consisted of disopyramide, ciprofloxacin, and lorazepam. There was no history of recent rash, paresthesias, fever, chills, nausea, genitourinary symptoms, bleeding from the colostomy, postprandial pain or bowel emptying, or in...

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Section: P Athological Discussionmentioning

confidence: 56%

Section: P Athological Discussionmentioning

confidence: 99%

Case 9-1995

Moncure¹,

Rashid²

1995

N Engl J Med

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“…It is usually divided into three clinical types based on the course and the severity: transient colitis, ischemic colitis with later development of stricture, and colonic necrosis 1 . Ischemic colitis can be classified into occlusive and non‐occlusive ischemia 2 . Most cases of non‐occlusive ischemic colitis undergo reversible colopathy, in which the lesions are limited to the mucosa and submucosa and transient colitis, and are usually associated with good prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…1 Ischemic colitis can be classified into occlusive and non-occlusive ischemia. 2 Most cases of non-occlusive ischemic colitis undergo reversible colopathy, in which the lesions are limited to the mucosa and submucosa and transient colitis, and are usually associated with good prognosis. But in severe cases, it may evolve into fulminant colitis with perforation, peritonitis, and sepsis.…”

Section: Introductionmentioning

confidence: 99%

Clinical and endoscopic features of ischemic colitis

Yang

et al. 2003

Chinese Journal of Digestive Diseases

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OBJECTIVE: To review the clinical and endoscopic features, and outcome of ischemic colitis. METHODS: Sixty cases with the diagnosis of ischemic colitis were retrospectively analyzed. All the patients were under observation in hospital and most of them underwent colonoscopy at least twice: once for diagnosis and then follow‐up after treatment. The demographic data, presenting symptoms, endoscopic findings, laboratory tests, and treatment were reviewed. RESULTS: Fifty‐two of the 60 cases were over 50 years old (87%; mean age, 59.9 years): 40 female, 20 male (2 : 1); 76.0% of these patients had a coexistent disease such as a cardio‐cerebrovascular disorder, diabetes, hematologic diseases or a previous history of abdominal surgery. Abdominal pain (57/60, 95%), hematochezia (55/60, 91.7%), and diarrhea (26/60, 43.3%) were the main complaints. Lesions seen on colonoscopy were more commonly located in the left colon (46/60, 79.3%) and rectum (5/60, 8.6%), and were characteristically segment‐distributed, including hemorrhagic edematous mucosa, erosions, ulcerations, pseudopolyps, and stricture. Ultrasonography revealed colonic wall thickening in 13 cases (13/55, 21.7%), and small to moderate ascites was detected in 4 cases (4/55, 7.3%). In this cohort, most of the patients recovered (49/60, 81.7%) or improved (10/60, 16.7%) after conservative treatment. Only one patient who had a myocardial infarction prior to the onset of the ischemic colitis, died from peritonitis complicated with septic shock. Progress and outcome were associated with the patient's age, severity of the lesions, clinical course, underlying diseases and the complications. CONCLUSION: Colonoscopy is safe and helpful in the early diagnosis of ischemic colitis. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis.

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“…Ischemic colitis consists of circulatory insufficiency to the colon and results in varying degree of local tissue injury or necrosis and systemic manifestations [1]. Ischemic colitis can be classified into occlusive and non occlusive ischemia [2, 3, 4]. The most common cause of ischemic colitis is iatrogenic interruption of the inferior mesenteric artery during aortic surgery [5, 6].…”

Section: Introductionmentioning

confidence: 99%

Ischemic Colitis during Pregnancy and Contraceptive Medication

Frossard¹,

Spahr²,

Queneau³

et al. 2001

Digestion

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Ischemic bowel disease is generally considered a disease of the elderly and usually consists of reversible colopathy. Nonocclusive causes of ischemic colitis include low-flow states due to cardiac dysfunction and hypovolemia and use of certain medications including progestational medication. We report 2 cases of ischemic colitis in young women. The first one occurred in a young patient who developed three consecutive episodes of ischemic colitis during her pregnancy, whereas the second woman presented with ischemic colitis in relation with the estrogen use. Each episode had a favorable outcome. Having ruled out an infectious cause, or a low blood flow state and in the absence of known thrombogenic disease, we hypothesized the etiology of these ischemic episodes to a high level of circulating estrogens due to pregnancy in the first case and oral contraceptive medication in the second. Physicians treating hemorrhagic colitis in young women should consider the use of contraceptive medication containing estrogens or pregnancy as possible causes.

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Ischemic Colitis

Cited by 6 publications

References 41 publications

Case 9-1995

Case 9-1995

Clinical and endoscopic features of ischemic colitis

Ischemic Colitis during Pregnancy and Contraceptive Medication

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