Colonoscopy-induced ischemic colitis in patients without risk factors

Lee, Sang Ok; Kim, Sae Hee; Jung, Sung Hee; Park, Chan Woong; Lee, Min Ji; Lee, Jin A; Koo, Hyun Cheol; Kim, Anna; Han, Hyun-Young; Kang, Dong-Wook

doi:10.3748/wjg.v20.i13.3698

Cited by 16 publications

(13 citation statements)

References 12 publications

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“…The etiology underlying colonoscopy-related CI has not been fully elucidated but, in agreement with other authors, the main cause seems to be barotrauma [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The pressure generated by the insufflated gas on the colonic wall would favor a hyperextension of it, which induces a reduction in total blood flow and a reduction in the arteriovenous oxygen gradient in the colonic wall, as already demonstrated in several experimental studies [ 13 ]. To suffer the most is the antimesocolic side, as demonstrated by our case: every vasa recta, before entering the colonic wall, divides into two branches that embrace the colonic lumen heading from the mesocolic to antimesocolic side, up to which developing a terminal type-like vascularization [ 5 ].…”

Section: Discussionsupporting

confidence: 66%

“…To suffer the most is the antimesocolic side, as demonstrated by our case: every vasa recta, before entering the colonic wall, divides into two branches that embrace the colonic lumen heading from the mesocolic to antimesocolic side, up to which developing a terminal type-like vascularization [ 5 ]. It was estimated that an intraluminal pressure of 30–40 mm Hg may induce a reversible impairment of the arterial circulation, but if it should exceed 50 mm Hg it may develop irreversible damage [ 13 ]. A confirmation of the barotrauma hypothesis is the lack of involvement of the middle-distal rectum as it has a dual blood supply that makes up for any lack of blood supply coming from the inferior mesenteric district.…”

Section: Discussionmentioning

confidence: 99%

“…However, we cannot exclude other possible suggested etiologies such as temporary twist mesocolon resulting in an extreme traction of the colonic wall which can reduce blood flow as well as repeated trauma to the colonic wall resulting in damage to the arterial microcirculation [ 10 , 13 , 14 ]. In addition, there are numerous possible predisposing conditions such as decrease of intravascular volume resulting from fasting and preparation as the prolonged duration of the procedure [ 1 , 5 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

Zizzo

Ruiz

Ugoletti

et al. 2016

Case Rep Gastroenterol

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Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI); only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in some cases in which the pathological process appears irreversible, surgery becomes mandatory.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

Zizzo

Ruiz

Ugoletti

et al. 2016

Case Rep Gastroenterol

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“…Gangrenous IC following lung wedge resection has also been reported [ 22 ]. Even rarer have been reports of IC following colonoscopy and colonic ischemia after vaginal delivery [ 23 , 24 ]. In addition, relatively young aged persons who habitually smoke are more likely to develop IC [ 25 ].…”

Section: Observations and Discussionmentioning

confidence: 99%

Diagnostic methods and drug therapies in patients with ischemic colitis

Xiong

et al. 2020

Int J Colorectal Dis

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Purpose Ischemic colitis (IC) is the most prevalent ischemic injury of thegastrointestinal tract. Clinical features of IC such as acute abdominal pain, hematochezia,and diarrhea are similar to those of acute mesenteric ischemia, inflammatorybowel disease, or infectious bowel disease, and their relative ambiguity candelay diagnosis and treatment. To comprehensively detail the current state ofdiagnostic methods and available drug therapies for detecting and treating IC,this review aims to provide a concise and practical summary of thecorresponding literature. Methods PubMed and Cochrane Library were searched toretrieve all published studies reporting the diagnostic methods and drugtherapies in patients with ischemic colitis. The search strategy of drugtherapy includes human and animal data. Results Colonoscopy combined with histopathologicalbiopsy is the standard of diagnosis for the IC. Most patients respond well tothe conservative treatment, and surgical consultation is needed when conservativetreatment is ineffective. Studies of potential drug therapy have beendeveloped, including phosphodiesterase type 5 inhibitors, pentoxifylline,rebamipide, prostaglandin E1, and polydeoxyribonucleotide. Conclusion Accurate diagnoses and effective treatmentshave helped reduce the mortality rate and improve prognoses for patientsafflicted with IC, and corresponding drug therapies have been constantlyupdated as new research has emerged.

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“…Laxation is universally used to cleanse the colon prior to colonoscopy. Development of colonic ischaemia following colonoscopy is rare and believed to be associated with haemodynamic instability from volume depletion after bowel preparation, gaseous distension of the bowel from insufflation causing decreased colonic blood flow, and/or the preparation itself . Bowel preparations have been observed to leave patients prone to colon ischaemia, with oral sulfate solution being the most common culprit, although the mechanism has not been studied in detail.…”

Section: Pharmacologic Agents Strongly Associated With Colon Ischaemiamentioning

confidence: 99%

Review article: the pharmacological causes of colon ischaemia

Vodusek

Feuerstadt

Brandt

2018

Aliment Pharmacol Ther

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Summary Background Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self‐resolving course. Aim To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes. Methods A PubMed search for “colon ischaemia” and “ischaemic colitis” alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed “moderate” or “strong” were included. Results The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation‐inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated. Conclusions Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.

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Colonoscopy-induced ischemic colitis in patients without risk factors

Cited by 16 publications

References 12 publications

Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

Diagnostic methods and drug therapies in patients with ischemic colitis

Review article: the pharmacological causes of colon ischaemia

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