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PubMed1989

Evidence of free radical (FR) involvement in ischemic colitis.

Early ischemic colitis was induced in rats to evaluate the roles of FRs and intraluminal content. After 30 minutes of ischemia, biopsies for histology, conjugated dienes (CD) and malonaldehyde (M), presumptive marker of lipid peroxidation, were obtained at 0, 30, and 60 minutes reperfusion. Histology was unchanged. CD and M were elevated in ischemic and saline controls, and rose progressively during reperfusion; CD and M were essentially the same as non-ischemic controls during reperfusion with intraluminal corticosteroid (c) and Alcide (A). These agents may be beneficial in early ischemic colitis.

Adrenal Cortex Hormones↗
PubMed1990

[Cholesterol crystal embolization, a rare cause of postoperative ischemic colitis].

An ischemic colitis of the descending Colon and Sigma in 3 patients following aorto-iliacal reconstruction was caused by embolism of cholesterol crystals. In all cases the stump pressure of the inferior mesenteric artery measured more than 40 Torr as an empiric value. Therefore a good collateral blood flow could be expected. Nevertheless a malperfusion of the left Colon occurred. These cases of postoperative ischemic colitis were caused by multiple cholesterol crystal emboli in the arterioles of the colon descendens and Sigma. The mobilisation and embolism of arteriosclerotic material during aorto-iliac reconstruction must be responsible for the unfortunate event. Awareness of a bowel ischemia following abdominal aortic surgery and immediate endoscopic control should lead to an early diagnosis and a higher survival rate. A decision to redo operation with left hemicolectomy is required at an early stage.

Aged↗
PubMed1979

Colitis in the elderly: ischemic colitis mimicking ulcerative and granulomatous colitis.

Eight patients over age 60 years had sudden onset of acute abdominal pain and rectal bleeding in the absence of prior inflammatory bowel disease. Several improved on medical therapy alone; those who required surgery suffered no recurrence up to 6 years. Although the pathologic specimens on these patients were first considered to represent ulcerative colitis or Crohn's disease, their histories and clinical courses are much more consistent with ischemic colitis. Since there are only a limited number of reactions that the bowel can muster against a host of damaging processes, histologic criteria alone are usually not sufficient to separate ischemic disease of the colon from ulcerative colitis and Crohn's disease. This is also true of radiographic features. Thus the diagnosis of ischemic colitis rests on clinical onset and course after treatment.

Aged↗
PubMed1997

Intraoperative photoplethysmographic diagnosis of ischemic colitis.

Intraoperative evaluation of ischemic colitis presents several problems related to diagnosis, severity, and extension. The aim of this study was to determine the usefulness of photopletysmography (PPG) to detect colonic arterial wave amplitude changes in patients operated on for ischemic colitis, comparing the affected area with a control area on the transverse colon. Four patients were studied, two with gangrenous colitis, and two with protracted "transient" ischemic colitis. All four patients survived. PPG is a useful method for intraoperative diagnosis and surgical assessment of ischemic colitis.

Aged↗
PubMed1980

[Clinical features of 27 cases of ischemic colitis (author's transl)].

The Authors report own experience of ischemic colitis, related to 27 cases, that includes either primitive forms (transient ischemic colitis, ischemic stricture and necrotic-gangrenous ischemic colitis) or secondary (occlusive ischemic colitis, ischemic colitis following abdominoperineal excision of the rectum). Pathogenetic findings, now not completely defined, are discussed with reference to the literature on this subject. The important diagnostic problems are also evaluated, particularly in the evaluation of radiologic and endoscopic findings of spontaneous ischemic colitis; these, altogether, represent an almost specific clinical picture of ischemic colitis. At last are considered the problems related to surgical treatment, overall in the forms in which the irreversibility of the ischemic lesions has been ascertained.

Aged↗
PubMed1970

Ischemic colitis.

Twenty cases of ischemic colitis are reviewed; 19 were obtained from autopsy files and the diagnosis in one was made from a surgical specimen. The majority of the patients were elderly with generalized arteriosclerosis. In approximately two-thirds of the patients the ischemic colitis was precipitated by preceding trauma, operation or congestive heart failure. Clinically, ischemic colitis is characterized by abdominal pain, distension and bleeding per rectum. Perforation of large bowel may occur. The lesions tend to be localized around the splenic flexure and junction of the descending and sigmoid colon, and in cases following aortic graft surgery the rectum is involved. Microscopically, there is necrosis, hemorrhage and ulceration. In less severe cases the mucosa only is affected. Cases with perforation show necrosis of all layers. It is considered that ischemic colitis is comparatively frequent and should be distinguished from other inflammatory conditions of the colon.

Aged↗
PubMed1996

Pelvic radiation therapy as a risk factor for ischemic colitis complicating abdominal aortic reconstruction.

Ischemic colitis is an infrequent but potentially devastating complication of abdominal aortic reconstruction. Identification of patients with predisposing risk factors for the development of ischemic colitis can guide intraoperative measures to preserve or restore colonic blood flow during aortic surgery. Previous radiation therapy for pelvic malignancy may be one such predisposing risk factor. Two cases are presented in which ischemic colitis complicated abdominal aortic reconstruction in the setting of previous pelvic irradiation. In the months after radiation therapy for prostate cancer, one patient underwent infrarenal abdominal aortic aneurysm repair. Ischemic infarction of the sigmoid colon developed acutely after surgery and required emergent sigmoid colectomy. The second patient underwent reconstruction of an infrarenal abdominal aortic aneurysm after having had radiation therapy for a bladder tumor. Despite an initial satisfactory result, the patient's abdominal pain and diarrhea progressively worsened and he eventually required sigmoid colectomy for severe ischemic colitis. In both of these patients, the inferior mesenteric arteries were patent and had not been reimplanted. The association of pelvic radiation therapy with ischemic colitis after aortic reconstruction should focus attention to the operative details for maintaining the colonic circulation in these patients. Reimplantation of the inferior mesenteric artery in particular may prevent both the acute and the insidious variants of this complication in patients who undergo aortic surgery and decrease the incidence of this complication in patients with a history of radiation therapy to the pelvis.

Aged↗
PubMed1977

Ischemic colitis.

Fifteen patients with ischemic colitis were treated; in every case the diagnosis was made at operation or autopsy. Abdominal pain, tenderness, and distention were the most common findings. Five patients had the transient form of the disease, two stricturing, and eight gangrenous. Five patients were operated upon, two because of stricturing disease, three because of gangrene of the colon. Both of the former patients survived, one of the latter. Diagnosis of transient ischemic colitis can be made by barium enema studies. This form of the disease is self-limiting and recovery should be expected. Stricturing ischemic colitis may be diagnosed by barium enema, but doubtful cases will require laparotomy and resection. It is difficult, if not impossible, to differentiate the gangrenous form of the disease from other abdominal catastrophes without operation. When the condition is found at celiotomy, bowel resection without anastomosis is recommended.

Aged↗
PubMed1997

Transient ischemic colitis in young adults.

Although ischemic colitis is often considered a condition of elderly persons or persons with vascular disease, it also occurs in healthy adults under age 60. While some patients may have gangrenous forms of ischemic colitis, others may have a benign, self-limited form of the disorder. In these cases, the condition is termed "transient ischemic colitis." This disorder should be included in the differential diagnosis in patients presenting with abdominal pain and hematochezia or bloody diarrhea. Estrogen or oral contraceptive therapy is associated with transient ischemic colitis, so its use should further raise suspicion. The effectiveness of discontinuation of estrogen therapy is controversial, but this measure should be considered. Conservative management includes repeated careful assessment, pain management and fluid replacement. Complications are rare and the prognosis is excellent. Occasionally, patients have recurrences.

Adult↗
PubMed1997

Spectrum of ischemic colitis in cocaine users.

Ischemic enterocolitis is a well-recognized entity occurring in cocaine users. Diagnosis is based on the presence of rectal bleeding, abdominal pain, a history of cocaine use, supportive endoscopic and histopathologic findings, and the absence of other etiologic mechanisms of ischemic colitis. In this study, we evaluated endoscopic and histopathologic findings in seven patients with cocaine colitis. Lesions seen by endoscopy, which were restricted to the left colon, included hemorrhagic edematous mucosa, pseudopolyps, and ulcerations. Rectal involvement, not a common feature of ischemic colitis, was seen in five patients. In two patients histologic lesions were classified acute/subacute, and in three patients as subacute/chronic. In the remaining two patients lesions were combined acute/subacute and chronic. The presence of subacute/chronic lesions suggested recurrent ischemic episodes and could reflect repeated use of cocaine. Future studies will be needed to define the long-term clinical and histopathologic significance of these subacute/chronic lesions.

Adult↗
PubMed2001

Ischemic colitis associated with paclitaxel.

Systemic chemotherapy can be complicated by colonic toxicity, which usually determines the onset of pseudomembranous colitis and, rarely, of ischemic colitis in patients with cancer. This report describes the case of a 49-year-old woman with liver metastases from a neuroendocrine tumor of unknown origin who developed mild ischemic colitis after chemotherapy with carboplatin and paclitaxel. The patient developed symptoms of gastrointestinal toxicity with abdominal pain and bloody diarrhea, which resolved in about 10 days. She had a normal white blood cell count throughout her illness; the assay of stool specimens for Clostridium difficile toxins and the stool cultures were both negative. A sigmoidoscopy showed a mild, transient ischemic colitis, which was confirmed by pathologic examination of the biopsy specimens. Although carboplatin is not related to severe colonic cytotoxicity, it has been previously reported that paclitaxel induces necrosis of the gastrointestinal mucosa and inhibits angiogenesis. Pseudomembranous colitis is the most frequent complication in patients with cancer who undergo paclitaxel-based chemotherapy and develop gastrointestinal toxicity. Once C. difficile infection has been excluded, a diagnosis of ischemic colitis should be considered, especially in patients with cancer who have normal white blood cell counts.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2001

Ischemic colitis during pregnancy and contraceptive medication.

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.

Adult↗
PubMed2005

Hypoxia-inducible factor 1 alpha and vascular endothelial growth factor overexpression in ischemic colitis.

AIM: To examine the etiology and pathophysiology in human ischemic colitis from the viewpoint of ischemic factors such as hypoxia-inducible factor 1 alpha (HIF-1 alpha and vascular endothelial growth factor (VEGF). METHODS: Thirteen patients with ischemic colitis and 21 normal controls underwent colonoscopy. The follow-up colonoscopy was performed in 8 patients at 7 to 10 d after the occurrence of ischemic colitis. Biopsy samples were subjected to real-time RT-PCR and immunohistochemistry to detect the expression of HIF-1 alpha and VEGF. RESULTS: HIF-1 alpha and VEGF expression were found in the normal colon tissues by RT-PCR and immunohistochemistry. HIF-1 alpha and VEGF were overexpressed in the lesions of ischemic colitis. Overexpressed HIF-1 alpha and VEGF RNA quickly decreased to the normal level in the scar regions at 7 to 10 d after the occurrence of ischemic colitis. CONCLUSION: Constant expression of HIF-1 alpha and VEGF in normal human colon tissue suggested that HIF-1 alpha and VEGF play an important role in maintaining tissue integrity. We confirmed the ischemic crisis in ischemic colitis at the molecular level, demonstrating overexpression of HIF-1 alpha and VEGF in ischemic lesions. These ischemic factors may play an important role in the pathophysiology of ischemic colitis.

Case-Control Studies↗
PubMed2004

Outcome of patients with ischemic colitis: review of fifty-three cases.

PURPOSE: Ischemic colitis is a disease of elderly patients and includes a wide clinical spectrum ranging from mild to severe forms. Some patients may develop complications. Management of this disorder depends on disease severity. Our aim was to review the clinical characteristics of patients diagnosed of ischemic colitis and analyze predictive factors of poor prognosis. METHODS: This study is a retrospective analysis of 53 cases of ischemic colitis (33 men, 20 women), 35 with moderate and 18 with severe forms, respectively. Clinical characteristics, diagnostic procedures, segment of colon involved and long-term evolution after discharge were analyzed. RESULTS: Hypertension (51 percent) was the main risk factor associated with ischemic colitis. Clinical presentation did not differ between groups, except for peritonitis which was present only in the severe group. Colonoscopy and histologic studies were the most used diagnostic procedures (90 percent). Peripheral vasculopathy (P < 0.01) and right colonic involvement (P < 0.001) were risk factors for severe outcome. Five patients died during admission. Among these, the right colon was affected in four (80 percent). No patient in either group developed chronic ischemic colitis during follow-up. CONCLUSION: Ischemic colitis usually runs a benign course after acute colonic insult. Peripheral vasculopathy and right colonic involvement are associated with severe forms of ischemic colitis.

Age Factors↗