Colonoscopy-related colonic ischemia

Abstract

Colonoscopy is a risk factor for colon ischemia. The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs; the etiology of colon ischemia after colonoscopy is multifactorial. The causative mechanisms include splanchnic circulation impairment, bowel preparation, drugs used for sedation, bowel wall ischemia due to insufflation/barotrauma, and introduction of the endoscope. Gastroenterologists must be aware of this condition and its risk factors for risk minimization, early diagnosis, and proper treatment.

Keywords: Bowel preparation; Colon ischemia; Colonoscopy; Endoscopy; Ischemic colitis; Mesenteric circulation.

Figure 1

Abdominal computed tomography with intravenous contrast, sagittal scan showing thrombosis of the superior mesenteric artery and the common hepatic artery (arrows).

Figure 2

Splanchnic vascular anatomy, detail of colonic arteries (Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 54523.

Figure 3

Endoscopic signs of ischemia, showing moderate diffuse erythema (A), severe erythema with mucosal edema and erosions (B), multiple ulcerations and inflammatory exudate (C), necrosis (D).