Ischemic colitis

Abstract

Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops "spontaneously," in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis.

Ischemic Colitis: Surging Waves of Update

“…While surgery is indicated for the gangrenous form of this disease, transient and structuring forms are often ameliorated by bowel rest, fasting, and/or parenteral fluid administration. The duration of fasting and fluid administration varies among individuals (Gandhi et al 1996). Significant prolongation of healing is sometimes observed, especially in patients with an ulcer.…”

Bowel obstruction as a result of ischemic colitis: Review of literature with contribution of one case report

“…Another similar zone is the distal sigmoid colon, supplied on one hand by the inferior sigmoid arteries, and on the other hand by the superior rectal artery (Sonneland, Anson, and Beaton, 1958). The ascending colon is also subject to ischemic attacks -in cases of absence or insufficient development of the artery of Drummond (Gandhi et al, 1996;Landreneau and Fry, 1990). Most classifications of intestinal ischemia in literature are based on the main ethiological factors.…”

“…The clinical course of the ischemic colitis is divided in two major groups of patients with gangrene form (15-20%) and patients with non-gangrene form (80-85%). In the nongangrene form the lesions can be transient and reversible, and can progress to chronic and non-reversible stenosis (10-15%) or chronic segmented colitis (20-25%) (Gandhi et al, 1996;Guttormson and Bubrick, 1989). In the beginning, the clinical manifestations in most of patients are non-specific and start with moderate abdominal pain from the engaged by ischemia part of intestines.…”

Ischemic Colitis

“…Mild-tomoderate abdominal tenderness is usually present over the involved segment of bowel. Patients with ischemia isolated to the right side of the colon more often present with lower abdominal pain than they do with rectal bleeding or bloody diarrhea [4][5][6][7][8].…”