Ischemic colitis: The ABCs of diagnosis and surgical management

Abstract

Ischemic colitis (IC) is a rare condition. As ischemia is often transient and clinical symptoms are reversible, its exact incidence is unknown. In current clinical practice, two types of IC are described according to the severity: severe IC, with transmural colonic ischemia and/or multi-organ failure (MOF), and mild IC, without MOF and spontaneous favourable evolution in most cases. Two clinical contexts are encountered: spontaneous IC (SIC) and postoperative IC (POIC), mainly after aortic surgery. As there is no specific clinico-biologic symptom of IC, emergent CT-scan and rectosigmoidoscopy are required for diagnosis confirmation, surgical decision and prognosis analysis. IC surgical treatment is not consensual but can be standardized according to organ function and the degree of ischemia: surgical treatment in case of colonic necrosis with deep ischemia and/or MOF; observation for superficial ischemia without organ dysfunction; systematic medical care. Surgery is required in 20% of cases, and consists in extended colectomy without continuity restoration and prophylactic cholecystectomy. Continuity restoration is feasible in one third of survivors, who are exposed to a high risk of severe cardiovascular events.

Procalcitonin and intestinal ischemia: A review of the literature

“…Intestinal ischemia is a common complication of intestinal diseases (e.g., small bowel obstruction and ischemic colitis) that can occur during disease progression (either spontaneously or after abdominal or cardiovascular surgery) [1,2] . The condition has been defined as impairment of the intestinal blood supply from the celiac axis, the superior mesenteric artery and the inferior mesenteric artery; this results in tissue injury and a low-flow state with poor intestinal arterial perfusion [3,4] .…”

New biomarkers for outcomes of acute mesenteric ischemia

“…Ischemic colitis (IC) and small bowel ischemia are not associated with a similar prognosis, which is greatly reduced after IC [2]. Furthermore, the localization of the damage imposes the use of various therapeutic management strategies, especially local or extended surgical gestures that are not described in this study.…”

Role of ultrasound in colorectal diseases

“…In 80% of the cases it affects the left colon causing lower GI hemorrhage at the border of the area supplied by the superior and inferior mesenteric artery, or at the junction of the inferior mesenteric and hypogastric artery territory[55]. True arterial occlusion is rare, it is more commonly a result of an impairment in the micro-vascularization of the colonic wall[56].…”