Ischemic colitis overview: Difference between revisions
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==Overview== | ==Overview== | ||
Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. | Ischemic colitis is a medical condition in which [[inflammation]] and injury of the [[large intestine]] result from inadequate blood supply. | ||
==Causes== | ==Causes== | ||
Causes of the reduced blood flow can include changes in the systemic circulation (e.g. [[hypotension|low blood pressure]]) or local factors such as [[vasoconstriction|constriction of blood vessels]] or a [[blood clot]]. In most cases, no specific cause can be identified.<ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.</ref> | Causes of the reduced blood flow can include changes in the systemic [[circulation]] (e.g. [[hypotension|low blood pressure]]) or local factors such as [[vasoconstriction|constriction of blood vessels]] or a [[blood clot]]. In most cases, no specific cause can be identified.<ref>Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.</ref> | ||
==Differentiating Ischemic Colitis from other Diseases== | ==Differentiating Ischemic Colitis from other Diseases== | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel [[ischemia]].<ref name="pmid15043513">{{cite journal | author = Higgins P, Davis K, Laine L | title = Systematic review: the epidemiology of ischaemic colitis. | journal = Aliment Pharmacol Ther | volume = 19 | issue = 7 | pages = 729-38 | year = 2004 | id = PMID 15043513}}</ref><ref name="pmid10784596">{{cite journal |author=Brandt LJ, Boley SJ |title=AGA technical review on intestinal ischemia. American Gastrointestinal Association |journal=Gastroenterology |volume=118 |issue=5 |pages=954-68 |year=2000 |pmid=10784596}}</ref><ref name="pmid10784595">{{cite journal |author=American Gastroenterological Association |title=American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia |journal=Gastroenterology |volume=118 |issue=5 |pages=951-3 |year=2000 |pmid=10784595}} http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295</ref> | Although uncommon in the general [[population]], ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel [[ischemia]].<ref name="pmid15043513">{{cite journal | author = Higgins P, Davis K, Laine L | title = Systematic review: the epidemiology of ischaemic colitis. | journal = Aliment Pharmacol Ther | volume = 19 | issue = 7 | pages = 729-38 | year = 2004 | id = PMID 15043513}}</ref><ref name="pmid10784596">{{cite journal |author=Brandt LJ, Boley SJ |title=AGA technical review on intestinal ischemia. American Gastrointestinal Association |journal=Gastroenterology |volume=118 |issue=5 |pages=954-68 |year=2000 |pmid=10784596}}</ref><ref name="pmid10784595">{{cite journal |author=American Gastroenterological Association |title=American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia |journal=Gastroenterology |volume=118 |issue=5 |pages=951-3 |year=2000 |pmid=10784595}} http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295</ref> | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop [[sepsis]] and become critically ill.<ref>{{cite journal | author = Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J | title = Outcome of patients with ischemic colitis: review of fifty-three cases. | journal = Dis Colon Rectum | volume = 47 | issue = 2 | pages = 180-4 | year = 2004 | id = PMID 15043287}}</ref> Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a [[stricture]]<ref>{{cite journal | author = Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279-81 | year = 1995 | id = PMID 7590579}}</ref> or chronic colitis.<ref>{{cite journal | author = Cappell M | title = Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 4 | pages = 827-60, vi | year = 1998 | id = PMID 9890115}}</ref> | Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe [[ischemia]] may develop [[sepsis]] and become critically ill.<ref>{{cite journal | author = Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J | title = Outcome of patients with ischemic colitis: review of fifty-three cases. | journal = Dis Colon Rectum | volume = 47 | issue = 2 | pages = 180-4 | year = 2004 | id = PMID 15043287}}</ref> Most patients make a full recovery; occasionally, after severe [[ischemia]], patients may develop long-term complications such as a [[stricture]]<ref>{{cite journal | author = Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279-81 | year = 1995 | id = PMID 7590579}}</ref> or chronic [[colitis]].<ref>{{cite journal | author = Cappell M | title = Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 4 | pages = 827-60, vi | year = 1998 | id = PMID 9890115}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Ischemic colitis is characterized by [[abdominal pain]] which is out of proportion to physical findings, specifically excruciating abdominal pain despite limited focal tenderness. | Ischemic colitis is characterized by [[abdominal pain]] which is out of proportion to physical findings, specifically excruciating [[abdominal pain]] despite limited focal tenderness. | ||
===Physical Examination=== | ===Physical Examination=== | ||
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===Laboratory Findings=== | ===Laboratory Findings=== | ||
There are no specific blood tests for ischemic colitis, but an [[elevated white blood cell count]] may be present. | There are no specific [[blood tests]] for ischemic colitis, but an [[elevated white blood cell count]] may be present. | ||
===Abdominal X Ray=== | ===Abdominal X Ray=== | ||
Among patients with ischemic colitis, the plain [[X-ray]]s are often normal or show non-specific findings.<ref>{{cite journal | author = Smerud M, Johnson C, Stephens D | title = Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. | journal = AJR Am J Roentgenol | volume = 154 | issue = 1 | pages = 99-103 | year = 1990 | id = PMID 2104734}}</ref> In a series of 73 patients, plain abdominal radiography showed [[ | Among patients with ischemic colitis, the plain [[X-ray]]s are often normal or show non-specific findings.<ref>{{cite journal | author = Smerud M, Johnson C, Stephens D | title = Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. | journal = AJR Am J Roentgenol | volume = 154 | issue = 1 | pages = 99-103 | year = 1990 | id = PMID 2104734}}</ref> In a series of 73 patients, plain abdominal radiography showed colonic [[distension]] in 53% of patients or a [[pneumoperitoneum]] in 3%.<ref>Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F (2006). "Ischemic colitis". Am. J. Surg. 192 (5): 679–84. doi:10.1016/j.amjsurg.2005.09.018</ref> | ||
===CT=== | ===CT=== | ||
Among patients with ischemic colitis, the CT scan shows mild to moderate diffuse bowel wall thickening and marked hyperenhancement of the mucosa. | Among patients with ischemic colitis, the [[CT scan]] shows mild to moderate diffuse bowel wall thickening and marked hyperenhancement of the mucosa. | ||
===Endoscopy=== | ===Endoscopy=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply.
Causes
Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.[1]
Differentiating Ischemic Colitis from other Diseases
Ischemic colitis must be differentiated from the many other causes of abdominal pain and rectal bleeding (for example, infection, inflammatory bowel disease, diverticulosis, or colon cancer).
It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the small bowel.
Epidemiology and Demographics
Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.[2][3][4]
Natural History, Complications and Prognosis
Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.[5] Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture[6] or chronic colitis.[7]
Diagnosis
History and Symptoms
Ischemic colitis is characterized by abdominal pain which is out of proportion to physical findings, specifically excruciating abdominal pain despite limited focal tenderness.
Physical Examination
Ischemic colitis is characterized by abdominal pain which is out of proportion to physical findings, specifically excruciating abdominal pain despite limited focal tenderness.
Laboratory Findings
There are no specific blood tests for ischemic colitis, but an elevated white blood cell count may be present.
Abdominal X Ray
Among patients with ischemic colitis, the plain X-rays are often normal or show non-specific findings.[8] In a series of 73 patients, plain abdominal radiography showed colonic distension in 53% of patients or a pneumoperitoneum in 3%.[9]
CT
Among patients with ischemic colitis, the CT scan shows mild to moderate diffuse bowel wall thickening and marked hyperenhancement of the mucosa.
Endoscopy
Among patients with a suspicion of ischemic colitis, endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the diagnostic procedure of choice if the diagnosis remains unclear after other imaging studies.
Treatment
Medical Therapy
Except in the most severe cases, ischemic colitis is treated with supportive care.
Surgery
Patients with ischemic colitis who develop worsening symptoms and signs such as high white blood cell count, fever, worsened abdominal pain, or increased lower gastrointestinal bleeding, may require surgical intervention which often consists of laparotomy and bowel resection.
References
- ↑ Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.
- ↑ Higgins P, Davis K, Laine L (2004). "Systematic review: the epidemiology of ischaemic colitis". Aliment Pharmacol Ther. 19 (7): 729–38. PMID 15043513.
- ↑ Brandt LJ, Boley SJ (2000). "AGA technical review on intestinal ischemia. American Gastrointestinal Association". Gastroenterology. 118 (5): 954–68. PMID 10784596.
- ↑ American Gastroenterological Association (2000). "American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia". Gastroenterology. 118 (5): 951–3. PMID 10784595. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295
- ↑ Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J (2004). "Outcome of patients with ischemic colitis: review of fifty-three cases". Dis Colon Rectum. 47 (2): 180–4. PMID 15043287.
- ↑ Simi M, Pietroletti R, Navarra L, Leardi S (1995). "Bowel stricture due to ischemic colitis: report of three cases requiring surgery". Hepatogastroenterology. 42 (3): 279–81. PMID 7590579.
- ↑ Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia". Gastroenterol Clin North Am. 27 (4): 827–60, vi. PMID 9890115.
- ↑ Smerud M, Johnson C, Stephens D (1990). "Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases". AJR Am J Roentgenol. 154 (1): 99–103. PMID 2104734.
- ↑ Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F (2006). "Ischemic colitis". Am. J. Surg. 192 (5): 679–84. doi:10.1016/j.amjsurg.2005.09.018