Diagnosis and management of ischemic colitis

Abstract

The clinical presentation and outcome of ischemic colitis has a wide spectrum. Impaired perfusion of blood to the bowel from a variety of causes is the underlying pathophysiology. The presence of diarrhea, abdominal pain, and mild lower gastrointestinal bleeding should prompt consideration of ischemic colitis as a cause. Although many laboratory tests and radiographic images may suggest the diagnosis, endoscopic visualization of colonic mucosa with histologic analysis of biopsies is the gold standard for identification of colonic ischemia. Most cases are transient and resolve without any complications. Medical therapy for chronic ischemia has been anecdotally proven but not carefully studied. Complications of ischemic colitis can include bowel perforation, peritonitis, persistent bleeding, protein-losing colopathy, and symptomatic intestinal strictures. Thus, surgical resection of the affected segment should be considered early to minimize adverse outcomes. This review describes the etiology, pathophysiology, clinical features, diagnostic approach, and management of ischemic colitis.

Ischemic Colitis Related to Sumatriptan Overuse

“…Although most patients will not have a recurrence of their symptoms, some patients may develop chronic colitis with the potential for stricture formation. 20 The patient presented in this case report was followed for 1 year after her initial diagnosis. She has had no further episodes of colitis.…”

Ischemic colitis: Clinical practice in diagnosis and treatment

“…In younger patients a predisposing cause is more easily recognized. Vasculitides, estrogens, cocaine and methamphetamine use, psychotropic drugs, sickle cell disease, long-distance running and heritable disorders of coagulation should be considered [19][20][21][22][23][24] . In a recent study [25] , the frequency of the 506 Q allele of the factor V (FV) 506 RQ (Leiden) mutation and the mutant 4G allele of plasminogen activator inhibitor (PAI) polymorphism were found to be significantly higher in young patients with IC compared with healthy controls.…”

Changing Trends in Lower Gastrointestinal Hemorrhage: A Rise in Frequency of Ischemic Colitis

“…Non-occlusive causes include hypotensive shock, volume depletion, impaired left ventricular function, or vasculitis among others. Ischemic colitis as defined in this study is distinct from these entities in that it is a mucosal phenomenon and is precipitated by increased intraluminal pressure (i.e., from constipation) based on LaPlace's law in addition to some non-occlusive factors mentioned above [14] [15].…”