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PubMed2005

Ischemic colitis: a clinical review.

Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.

Abdominal Pain↗

PubMed1977

Spontaneous ischemic colitis.

Eighteen cases of spontaneous ischemic colitis are reviewed. The diagnosis was established according to the following criteria: 1) clinical background, 2) clinical characteristics, 3) morphologic characteristics, and 4) clinical and morphologic course. The last three constituted the diagnostic criteria. The cases were divided into mild-to-moderate, moderate-to-severe, and gangrenous categories. Although data on clinical background did not establish the diagnosis of spontaneous ischemic colitis, they were essential in strict diagnosis. Patients who had histories of Crohn's disease, chronic ulcerative colitis, and recent antibiotic administration were excluded from consideration. Appropriate stool examinations obtained in all of the mild-to-moderate and all except two of the moderate-to-severe cases excluded colitis due to pathogenic bacterial organisms or parasites. Spontaneous ischemic colitis generally occurs in older individuals; the average age in our patients was 60 years. Twelve of the 18 patients had at least some evidence of major cardiovascular disease.

Adult↗

PubMed1983

Experimental ischemic colitis in dogs.

Experimental ischemic colitis was produced in 42 dogs by either ligation (ligation group, n=18) or temporary occlusion of the mesenteric vessels (temporary occlusion group, n=24) and changes in the local blood flow in the bowel were measured by the hydrogen clearance method. Tissue damage similar to damage seen in patients with ischemic colitis were produced in both of these groups. There was a close correlation between the severity of the ischemia and the ensuing tissue damages. In the ligation group, the tissue damages ranging from erosions or minute ulcerations to diffuse ulcerations occurred when the local blood flow was measured at 30 minutes after the ligation and was below 50 per cent of the basal flow. In the temporary occlusion group, the tissue damages were observed when the local blood flow was below 40 per cent of the basal flow and the occlusion was maintained for over two hours.

Animals↗

PubMed1998

Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia.

Ischemic colitis accounts for approximately half of all cases of mesenteric vasculopathy. The clinical presentation varies depending on underlying cause, extent of vascular obstruction, rapidity of ischemic insult, degree of collateral circulation, and presence of comorbidity. Ischemic colitis is usually diagnosed by colonoscopy. Only approximately 20% of patients require surgery because of signs or laboratory findings of peritonitis or because of clinical deterioration. Approximately 20% of patients develop chronic colitis from irreversible colonic ischemic injury, which manifests clinically as persistent diarrhea, rectal bleeding, or weight loss and endoscopically as a colonic stricture or mass. Chronic mesenteric ischemia is almost always caused by significant atherosclerotic stenosis involving at least two mesenteric arteries, usually the superior mesenteric artery and celiac axis. The classic symptomatic triad of postprandial pain, fear of eating, and involuntary weight loss occurs with advanced disease.

Colitis, Ischemic↗

PubMed1986

Pathogenesis of nonocclusive ischemic colitis.

The nonocclusive component of ischemic colitis in anesthetized pigs was mimicked using cardiogenic shock produced by pericardial tamponade. Increases in pericardial pressure produced decreases in arterial pressure (PA) and cardiac output (CO), with corresponding rises in total peripheral resistance (i.e., cardiogenic shock). This was associated with marked reductions in blood flow through the inferior mesenteric artery (IMA), due primarily to disproportionate increases in IMA vascular resistance. Levels of plasma renin activity correlated closely with these changes in mesenteric hemodynamics. Confirmed, total alpha adrenergic blockade with phenoxybenzamine failed to block this selective mesenteric vasoconstriction, while ablation of the renin-angiotensin axis with captopril completely abolished it, thereby ameliorating the colonic ischemia. Central intravenous infusions of pathophysiologic levels of angiotensin II, without tamponade, mimicked the response to shock seen with tamponade alone. In an additional group of pigs, 4 hours of sustained shock (tamponade) followed by 2 hours of normotension (release of tamponade and resuscitation) produced lesions characteristic of ischemic colitis, including full-thickness mucosal ulceration. Such lesions were ameliorated significantly in pigs in which the renin-angiotensin system had been ablated by bilateral nephrectomy. Nonocclusive ischemic colitis appears to be mediated primarily by a remarkable sensitivity of the colonic vasculature to the renin-angiotensin axis.

Animals↗

PubMedDate not supplied

[Should subdivision of regressive ischemic colitis be envisaged?].

The term "regressive ischemic colitis" is generally accepted and refers to acute hemorrhagic colitis which may occur at any age and recovers spontaneously in most cases, sometimes leaving colonic stenosis due to scarring. Critical analysis of the literature reveals that there is no formal diagnostic criterion for this condition and no real proof that the mechanism is ischemic, particularly in young subjects who have no vascular disorder or hemodynamic triggering factor. The number of clinical, radiological, endoscopic and even histological similarities between regressive ischemic colitis and some forms of infectious colitis, particularly due to enterohemorrhagic E. coli O157:H7 and hemorrhagic colitis due to penicillin derivatives and non-steroid anti-inflammatory drugs is also striking. These observations logically lead us to wonder whether the term "regressive ischemic colitis" does really correspond to a well-defined entity rather than to a group of acute colitis of miscellaneous etiology but with many common features.

Adult↗

PubMed1994

[Experimental study on the etiology of ischemic colitis].

A reliable experimental model for ischemic colitis in rat could be obtained by ligating the marginal vessels of the colon 3 days after attaching the ring to induce partial colon obstruction. This model has the advantage of enabling to observe the chronic progress and the organ of the sideration to clarify the cause of ischemic colitis. The decrease of blood flow within the colonic mucosa continued up to 7 days after ligation in rat with partial obstruction, while no apparent abnormal changes were observed, and the previous level for several hours in the rats with out attaching the ring. This fact proved that the RT group is in a state easily developing sideration due to the sustained partial colon obstruction. The reactant reacting with thiobarbituric acid (TBA) was found to increase, in particular, 6 or more hours after ligation of vessels. A superoxide scavenger, liposomal-encapsulated superoxide dismutase (1-SOD) suppressed development of the ischemic lesion. The change in free radicals is therefore, considered to be involved in the occurrence of ischemic colitis.

Animals↗

PubMed2005

Diagnosis and management of ischemic colitis.

The clinical presentation and outcome of ischemic colitis has a wide spectrum. Impaired perfusion of blood to the bowel from a variety of causes is the underlying pathophysiology. The presence of diarrhea, abdominal pain, and mild lower gastrointestinal bleeding should prompt consideration of ischemic colitis as a cause. Although many laboratory tests and radiographic images may suggest the diagnosis, endoscopic visualization of colonic mucosa with histologic analysis of biopsies is the gold standard for identification of colonic ischemia. Most cases are transient and resolve without any complications. Medical therapy for chronic ischemia has been anecdotally proven but not carefully studied. Complications of ischemic colitis can include bowel perforation, peritonitis, persistent bleeding, protein-losing colopathy, and symptomatic intestinal strictures. Thus, surgical resection of the affected segment should be considered early to minimize adverse outcomes. This review describes the etiology, pathophysiology, clinical features, diagnostic approach, and management of ischemic colitis.

Clinical Trials as Topic↗

PubMed1986

Ischemic colitis and immunosuppression. An experimental model.

The incidence of ischemic colitis in renal transplant recipients approaches 1 percent. The mortality in these patients with ischemic colitis is nearly 70 percent. Immunosuppressive agents have been implicated in the development of ischemic colitis. To study the effect of immunosuppressive agents on ischemic colitis, a 4-cm segment of the colon was devascularized in 27 male Fischer rats. The animals were divided into one control and two treatment groups. One treatment group received methylprednisolone and the other, azathioprine, in doses similar to those of renal transplant recipients. Both experimental groups, either separately or combined, showed significantly greater areas of colonic ischemic changes than did the control group. This study demonstrates that systemic administration of immunosuppressive agents may augment the development of ischemic colitis.

Animals↗

PubMed1976

Ischemic colitis.

Although several hundred cases of ischemic colitis have been reported from western countries, no case has been reported in our country. Ischemic colitis is a well established entity. Clinicopathological manifestations, disgnosis, treatment and prognosis of the disease are well known. A majority of reported cases were not particularly unusual. Two cases, of which one showed an unusually long lasting acute episode but good prognosis, and the other presented a diagnostic problem and was found to have a fibrous stricture due to ischemic colitis in the sigmoid colon at surgery, were described and discussed in relation to their symptoms, diagnosis and prognosis.

Aged↗

PubMed1995

Reversible ischemic colitis in young women. Association with oral contraceptive use.

Ischemic colitis, a condition of middle-aged to elderly patients, occurs uncommonly in younger persons. In this study, we describe the clinical and pathological features of 18 young adults (mean age, 29 years; age range, 17-39 years) with spontaneous ischemic colitis, 17 of whom were women. All presented with abrupt onset of severe, cramping abdominal pain followed by hematochezia. Colonoscopic visualization of the mucosa showed segmental hyperemia, friability, and erosion affecting the distal transverse colon (three cases), splenic flexure (three cases), descending colon (five cases), and sigmoid (seven cases). Mucosal biopsy documented superficial ischemic necrosis in seven patients; 11 patients had full-thickness mucosal necrosis with regeneration. Colonic mucosa proximal and distal to the ischemic segment was endoscopically normal in all patients and histologically normal in the eight patients in whom biopsies were obtained. All patients recovered with supportive care. Median duration of illness was 2.1 days (range, 1-4 days). Ten women (59%) were using low-dose estrogenic oral contraceptive agents, compared with the 1988 national average of 18.5% oral contraceptive users among females aged 15 to 44 years. The calculated odds ratio yielded a greater than sixfold relative risk for the occurrence of ischemic colitis among oral contraceptive users. In addition, four women not currently on hormonal contraceptive therapy had a past history of oral contraceptive use; the three remaining women were taking estrogen as replacement therapy after oophorectomy. In one patient, documented reversible ischemic colitis recurred on resumption of oral contraceptive use; four women reported symptoms and signs of recurrent ischemia but did not seek further medical evaluation. Our data indicate that transient colonic ischemia represents a form of acute segmental colitis in young adults; before the 5th decade of life, spontaneous ischemic colitis is a disorder found almost exclusively in women and is associated with the clinical use of exogenous estrogenic agents.

Adolescent↗

PubMedDate not supplied

[Ischemic colitis in patients submitted to aortic replacement surgery. Risk factors].

UNLABELLED: Ischemic colitis (IC) is an important clinical problem, and may present after aortic surgical procedures. The aim of this work was to establish risk factors for IC presentation in aortic surgical replacement patients. MATERIAL AND METHODS: A retrospective study of patients with aortic surgical replacement in a 3-year period was carried out. Patients were divided into two groups: patients without IC and patients with IC, the later group subdivided into patients with gangrenous ischemic colitis and without gangrenous ischemic colitis. Multiple logistic regressions was used to obtain the variables for possible risk factor for IC. RESULTS: We included 101 patients in the study; ischemic colitis was present in 16.8% of all cases, with 47.1% of gangrenous type. Metabolic acidosis was the most frequent alteration. Diagnosis was made by endoscopy in 94.1%. Mortality in IC group was 18.2% with an increase in the gangrenous group to 62.5%. Identified risk factors were disrupted aneurysm, previous colonic surgery, emergency surgery, and hemodynamic instability. CONCLUSIONS: Ischemic colitis is most frequent in emergency surgery for disrupted aneurysm in the hemodynamically unstable patient with retroperitoneal hematoma. We must entertain a high suspicion index for IC in all patients with aortic surgical procedures for early detection and adequate treatment.

Acidosis↗

PubMed1995

Bowel stricture due to ischemic colitis: report of three cases requiring surgery.

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction that required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗

PubMed1995

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗

PubMed1997

Does laser Doppler flowmetry aid the prevention of ischemic colitis in abdominal aortic aneurysm surgery?

Acute ischemic colitis is noted as a rare but lethal complication of abdominal aortic aneurysm (AAA) surgery. Because of its high mortality a reliable method of monitoring colonic blood perfusion to predict the possible occurrence of ischemic colitis is highly desirable for AAA surgery. We have tested the use of a laser Doppler flowmeter placed on the surface of the sigmoid colon for intraoperative monitoring in 31 patients with AAA. Although most of the patients showed the same flow levels after aorto-iliac or aorto-femoral grafting (at least unilaterally the internal iliac artery was perfused), in 6 cases poor colonic perfusion (below 50% of the basal flow) was observed and inferior mesentric arterial reconstruction was performed. In these 6 patients, sigmoid colonic blood perfusion returned from 37% to 82% of preoperative value after the reconstructions. No ischemic colitis was noted in this series of patients. We suggest that monitoring of serosal blood flow in the sigmoid colon using a laser Doppler flowmeter is useful for the management of patients during abdominal aortic aneurysm surgery.

Acute Disease↗

PubMed1998

Reversible ischemic colitis in a high endurance athlete.

Ischemic colitis is a rare but serious consequence of long distance running. Herein we report a well documented case of severe ischemic colitis in an elite class marathon athlete in whom an extensive diagnostic evaluation, including magnetic resonance angiography and hypercoagulation profile, was performed. Our results suggest that physiologic shunting due to splanchnic vasoconstriction, intravascular volume depletion due to chronic dehydration, and possibly some element of hypercoaguability due to secondary polycythemia may have been causative factors. The patient's full recovery, both clinically and endoscopically, with conservative treatment and ability to resume a vigorous training schedule further support a reversible nonocclusive etiology.

Adult↗

PubMedDate not supplied

Ischemic colitis in young adults: a single-institution experience.

Ischemic colitis is not well characterized in the young adult population, despite its commonness in older patients. The aim of this study was to investigate the demographics, etiology, clinical features, and prognosis of ischemic colitis in young adults. We conducted a retrospective study of 39 young adults (<50 years of age) diagnosed with ischemic colitis over a period of 9 years (1990 to 1998). The mean age at diagnosis was 38 +/- 2 years (range 18 to 49 years); the female:male ratio was 1.8. Fifty-two percent (13 of 25) of women were using oral contraceptives at the time of diagnosis. Other potential associations identified were vascular thromboembolism (4 of 39), vasoactive drugs (4 of 39), hypovolemia (4 of 39), and vasculitis (2 of 39); 19 patients (49%) had no identifiable predisposing factors. Dominant presenting symptoms were abdominal pain (77%), bloody diarrhea (54%), and hematochezia (51%). Most patients were diagnosed at colonoscopy, and most disease was left sided. Twenty-nine patients were successfully managed with intravenous fluids, broad-spectrum antibiotics, and bowel rest; 10 patients required surgery. There was one disease-related death in the operative group. We found a strong female predominance and an association with oral contraceptive use, but almost half of the patients did not have an identifiable etiology. Mortality from ischemic colitis in this patient population is low.

Adult↗

PubMed1991

Ischemic colitis associated with dextroamphetamine use.

Ischemic colitis can be caused by a variety of medications including a number of sympathomimetic agents. We report the case of a 47-year-old narcoleptic man who had abdominal pain and rectal bleeding. The clinical, radiographic, and histologic findings supported the diagnosis of ischemic colitis associated with oral dextroamphetamine use.

Colitis↗