Ischemic colitis

Abstract

Most clinicians associate ischemic colitis with elderly patients who have underlying cardiovascular comorbidities. While the majority of cases probably occur in this population, the disease can present in younger patients as a result of different risk factors, making the diagnosis challenging. While a majority of patients respond to medical management, surgery is required in approximately 20% of the cases and is associated with high morbidity and mortality.

Keywords: colectomy; colonoscopy; ischemic colitis; lower gastrointestinal bleed.

Fig. 1

Vascular anatomy of the large intestine. Adapted with permission from Gordon PH, Nivatvongs S. Principles and Practice of Surgery for the Colon, Rectum and Anus. 2nd ed. St. Louis, MO: Quality Medical Publishing, Inc.; 1999.

Fig. 2

Computerized tomographic scan of coronal sections of the abdomen showing thickening of the splenic flexure, descending colon, and proximal sigmoid colon in a patient with documented ischemic colitis.

Fig. 3

Endoscopic photograph of colonic mucosa demonstrating: (A) mucosal bleeding, erythema, and intraluminal blood consistent with mild ischemic colitis; (B) ulceration, scattered erosions, and intraluminal clot consistent with severe colonic ischemia.

Fig. 4

Photograph from colonoscopy which demonstrates: (A) gangrenous mucosa and (B) a transition point, distally, to normal mucosa.

Fig. 5

Histologic photograph from a biopsy specimen of a patient with ischemic colitis which shows ulceration with fibrinous exudate, vascular congestion, and hemorrhage with associated acute inflammation and granulation tissue reaction.