Advents in the Diagnosis and Management of Ischemic Colitis

Abstract

Background: Ischemic colitis (IC) is a common type of ischemic insult, resulting from decreased arterial blood flow to the colon. This disease can be caused from either atherosclerotic occlusive vascular disease or non-occlusive disease. The aim of this study is to present the diagnostic methodology and management of this severe disease based on current literature.

Methods: A literature search has been done including articles referring to modern diagnosis and management of IC.

Results: IC is usually a transient disease, but it can also cause gangrene of the colon, requiring emergency surgical exploration. Diagnosis is troublesome and is based on imaging examinations, mainly computerized tomography, which in association with colonoscopy can delineate the distribution pattern and severity of disease.

Conclusion: The majority of patients with mild disease have usually complete clinical recovery within a short period. The severe forms of the disease carry high morbidity and mortality rates and prompt surgical intervention is the only way to improve the associated severe prognosis.

Keywords: colon; ischemia; necrosis; perforation; sepsis.

Figure 1

Abdominal CT showing diffuse thickening with layering of the wall of the sigmoid due to whole thickness ischemia.

Figure 2

Abdominal CT revealing diffuse dilatation of the sigmoid with gas infiltration of its submucosa due to severe whole thickness ischemia (the gangrenous subtype).

Figure 3

Abdominal CT of a 75-year-old patient who underwent endovascular abdominal aortic aneurysm repair with a covered aortic stent-graft. The patient had a type II endoleak via inferior mesenteric artery, and was treated with direct puncture and embolization with glue. Later, the patient presented severe colonic ischemia with sepsis. Embolic material is evident in the inferior mesenteric artery, whereas the sigmoid colon appears with thickened necrotic wall.

Figure 4

Colon infarction due to occlusion of the IMA may have devastating results. In this case there is gangrene of part of the sigmoid colon, which caused extensive rupture of the colonic wall and feculent peritonitis. Hartmann’s procedure was performed in this case with positive result.