Clinical and endoscopic features of ischemic colitis

Abstract

OBJECTIVE: To review the clinical and endoscopic features, and outcome of ischemic colitis. METHODS: Sixty cases with the diagnosis of ischemic colitis were retrospectively analyzed. All the patients were under observation in hospital and most of them underwent colonoscopy at least twice: once for diagnosis and then follow‐up after treatment. The demographic data, presenting symptoms, endoscopic findings, laboratory tests, and treatment were reviewed. RESULTS: Fifty‐two of the 60 cases were over 50 years old (87%; mean age, 59.9 years): 40 female, 20 male (2 : 1); 76.0% of these patients had a coexistent disease such as a cardio‐cerebrovascular disorder, diabetes, hematologic diseases or a previous history of abdominal surgery. Abdominal pain (57/60, 95%), hematochezia (55/60, 91.7%), and diarrhea (26/60, 43.3%) were the main complaints. Lesions seen on colonoscopy were more commonly located in the left colon (46/60, 79.3%) and rectum (5/60, 8.6%), and were characteristically segment‐distributed, including hemorrhagic edematous mucosa, erosions, ulcerations, pseudopolyps, and stricture. Ultrasonography revealed colonic wall thickening in 13 cases (13/55, 21.7%), and small to moderate ascites was detected in 4 cases (4/55, 7.3%). In this cohort, most of the patients recovered (49/60, 81.7%) or improved (10/60, 16.7%) after conservative treatment. Only one patient who had a myocardial infarction prior to the onset of the ischemic colitis, died from peritonitis complicated with septic shock. Progress and outcome were associated with the patient's age, severity of the lesions, clinical course, underlying diseases and the complications. CONCLUSION: Colonoscopy is safe and helpful in the early diagnosis of ischemic colitis. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis.

The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

“…The commonest symptom was abdominal pain, which was reported in 18 studies [3–6, 10–13, 16–18, 21, 23, 25–28, 32]. The nature and exact location of the abdominal pain were not elaborated upon.…”

“…Non‐bloody diarrhoea was found in 944/2444 (38.6%) of patients and was the third most frequent symptom reported in 19 studies [3, 5, 6, 10–16, 21, 22, 25–28]. It was most common in those presenting with IRCI compared to non‐IRCI, 96/256 (37.5%) versus 144/502 (28.6%), respectively.…”

“…Nausea and/or vomiting were found in 281/972 (28.9%) of the patients [4–6, 11, 13, 14, 16–18, 24, 26, 28]. The frequency between IRCI and non‐IRCI was 56% and 40%, respectively, and between mild and severe colitis was 20% and 37.7%, respectively.…”

Can We Predict the Development of Ischemic Colitis Among Patients with Lower Abdominal Pain?

“…[Key words: Ischemic colitis; Risk factors; Low abdominal pain] I schemic colitis (IC) is the most common form of ischemic injury of the gastrointestinal tract and is caused by circulatory insufficiency to the colon. [1][2][3][4] It is comprised of several types, differentiated by course and severity: transient colitis, chronic ulcerating colitis with stricture, gangrene, and fulminant universal colitis. It also can be classified as occlusive and nonocclusive ischemia: most are nonocclusive.…”

“…[5][6][7][8] Various clinical situations have been recognized to trigger IC, including vascular surgery, vascular thromboembolism, cardiac dysfunction, hypovolemia, medications, such as vasopressin, nonsteroidal anti-inflammatory drugs (NSAIDs), or oral contraceptives, and some diseases increasing visceral intraluminal pressure. [1][2][3][4][6][7][8] In clinical situations, patients with IC usually present with abdominal pain with or without bloody diarrhea. [4][5][6][7] It may be highly fatal if not treated appropriately and particularly dangerous when accompanied with shock, heart failure, ischemic heart disease, or severe dehydration.…”