Large Intestine: Ischemic Colitis

Ischemic Colitis

Basics

  • Inflammation Caused by Ischemia
  • Can Lead to Mucosal Injury or Full-Thickness Necrosis/Perforation
  • Most Common Site: Watershed Areas
  • Most Have Less Severe Disease & Can Be Managed Medically
  • Can be Acute or Chronic

Causes

  • Nonocclusive/Low Flow States (Most Common)
    • Most Cases Have No Specific Cause Defined
    • Sepsis
    • Hemorrhagic Shock
    • Hypotension
    • Myocardial Infarction
    • Hemodialysis
    • Cardiopulmonary Bypass
    • Medications (Opioids, etc)
  • Occlusive
    • Thrombus
    • Emboli

Symptoms

  • Abdominal Pain
  • Diarrhea
  • Hematochezia
  • Nausea & Vomiting
  • Fever

Diagnosis

  • Initial Test: CT – Often Suggestive but Nonspecific
  • Then Colonoscopy (Gold Standard) if No Immediate Indications for Surgery
    • No Bowel Prep
    • Minimize Insufflation
    • Do Not Advance Past Distal Extent of the Disease

Treatment

  • Initial Tx: Conservative (Bowel Rest, IV Fluid Resuscitation & ABX)
    • Treat Any Underlying Etiology
    • Serial Abdominal Exams
    • ABX to Protect from Bacterial Translocation
  • Surgical Resection Indications:
    • Gangrenous Bowel
    • Perforation
    • Peritonitis
    • Sepsis
    • Massive Hemorrhage
    • Unstable

Ischemic Colitis on Colonoscopy 1

Ischemic Colitis on CT 2

References

  1. Kum F, Gulati A, Hussain A. Hyperamylasaemia and ischaemic colitis. Int J Surg Case Rep. 2014;5(2):63-6. (License: CC BY-NC-SA-3.0)
  2. Viswanathan C, Bhosale P, Ganeshan DM, Truong MT, Silverman P, Balachandran A. Imaging of complications of oncological therapy in the gastrointestinal system. Cancer Imaging. 2012 May 7;12(1):163-72. (License: CC BY-4.0)