Ischemic colitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Ischemic colitis can span a wide spectrum of severity. Majority of patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill. Most patients make a full recovery. Occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis.
Natural History
The symptoms of ischemic colitis usually develop in the sixth decade of life, and start with symptoms such as abdominal pain, bloody diarrhea, and vomiting.
Three progressive phases of ischemic colitis have been described:[1][2][3][4][5]
Ischemic colitis can be classified into:[1][2][3][4][5] Reversible ischemic colopathy This type is characterized by submucosal haemorrhage at endoscopy, with involvement of superficial mucosa. It is typically self-limiting. Transient: the most common form at These patients present with abdominal pain, per-rectal bleeding and full-thickness involvement of the mucosa. Chronic segmental or chronic ulcerative These patients present with persistent symptoms or recurrent episodes of pain, per-rectal bleeding, diarrhoea, and segmental colitis on imaging. Resection is often curative. Ischaemic colonic stricture This may be detected acutely, however, more frequently is found at follow-up endoscopy. Gangrenous colitis This should be suspected when there is increasing abdominal pain, signs of local or generalized peritonitis, fevers or associated ileus. Universal fulminant pancolitis This presents acutely with severe symptoms, progressive transmural infarction and necrosis of the entire colon, resultant sepsis and perforation. 75% mortality rate. These patients present with sepsis, severe abdominal pain, peritonitis and per-rectal bleeding.
Complications
The complications of ischemic colitis are as follows:[6][7][8][9]
- About 20% of patients with acute ischemic colitis may develop a long-term complication known as chronic ischemic colitis.
- Symptoms can include recurrent infections, bloody diarrhea, weight loss, and chronic abdominal pain.
- Chronic ischemic colitis is often treated with surgical removal of the chronically diseased portion of the bowel.
- A colonic stricture is a band of scar tissue which forms as a result of the ischemic injury and narrows the lumen of the colon.
- Strictures are often treated observantly; they may heal spontaneously over 12-24 months.
- If a bowel obstruction develops as a result of the stricture, surgical resection is the usual treatment although endoscopic dilatation and stenting have also been employed.
Prognosis
The prognosis of ischemic colitis is as follows:[10][11]
- Majority of patients with ischemic colitis recovery fully, although the prognosis depends on the severity of the ischemia.
- Patients with pre-existing peripheral vascular disease or ischemia of the ascending (right) colon may be at increased risk for complications or death.
- Non-gangrenous ischemic colitis, which comprises the majority of cases, is associated with a mortality rate of approximately 6%.
- Minority of patients who develop gangrene as a result of colonic ischemia have a mortality rate of 50-75% with surgical treatment.
- Mortality rate is almost 100% without surgical intervention.
References
- ↑ 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.
- ↑ Boley, SJ, Brandt, LJ, Veith, FJ. Ischemic disorders of the intestines. Curr Probl Surg 1978; 15:1.
- ↑ Hunter G, Guernsey J (1988). "Mesenteric ischemia". Med Clin North Am. 72 (5): 1091–115. PMID 3045452.
- ↑ Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia". Gastroenterol Clin North Am. 27 (4): 827–60, vi. PMID 9890115.
- ↑ Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia". Gastroenterol Clin North Am. 27 (4): 827–60, vi. PMID 9890115.
- ↑ 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.
- ↑ Oz M, Forde K (1990). "Endoscopic alternatives in the management of colonic strictures". Surgery. 108 (3): 513–9. PMID 2396196.
- ↑ Profili S, Bifulco V, Meloni G, Demelas L, Niolu P, Manzoni M (1996). "self-expandable uncoated metallic prosthesis". Radiol Med (Torino). 91 (5): 665–7. PMID 8693144.
- ↑ Longo W, Ballantyne G, Gusberg R (1992). "Ischemic colitis: patterns and prognosis". Dis Colon Rectum. 35 (8): 726–30. PMID 1643995.
- ↑ Parish K, Chapman W, Williams L (1991). "Ischemic colitis. An ever-changing spectrum?". Am Surg. 57 (2): 118–21. PMID 1992867.