Colonic ischemia

Definition

Ischemic colitis involves an area of inflammation (irritation and swelling) caused by interference with the blood flow to the colon (large intestine).

Alternative Names

Causes

Interference with blood flow to the colon is the cause of ischemic colitis. The disorder mainly affects people over 50, many of whom have a history of peripheral vascular disease. Other risk factors include:

• Previous aortic surgery with unintentional damage to the artery supplying the colon
• History of stroke
• Low blood pressure
• Congestive heart failure 
• Diabetes 
• Abdominal radiation exposure

Symptoms

• Abdominal pain
• Fever
• Vomiting
• Bright redblood in the stool
• Diarrhea

Exams and Tests

• Colonoscopy or flexible sigmoidoscopy showing inflamed mucosa or ulcers in the colon
• Angiography showing a vascular (blood vessel) lesion

Treatment

Mild, transient ischemic colitis is treated by maintaining good blood pressure. This can be done with medicines and avoiding dehydration. Antibiotics are sometimes used.

Chronic ischemic colitis leading to stricture formation (areas of narrowed colon) is treated by surgical removal of the stricture.

Severe ischemic colitis leading to gangrene is treated with replacement of blood volume, antibiotics, and surgical removal of the affected bowel area.

Outlook (Prognosis)

Most cases of ischemic colitis are mild, self-limited, and do not require therapy. The death rate is high when gangrene occurs as a result of inadequate blood supply.

Possible Complications

• Gangrene of the bowel
• Perforation (hole in the intestine)
• Peritonitis (inflammation of the lining of the abdomen)
• Sepsis

When to Contact a Medical Professional

Call your health care provider if symptoms of ischemic colitis develop.

Prevention

Awareness of risk may allow early diagnosis and treatment. Absolute prevention may not be possible.

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