Ischemic Colitis

Sun, Mark Y.; Maykel, Justin A.

doi:10.1055/s-2007-970194

Cited by 20 publications

(11 citation statements)

References 25 publications

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“…Radiography has little to no role in the diagnosis of chronic mesenteric ischemia because these patients have not yet developed bowel necrosis, and therefore the radiograph will likely be normal or demonstrate nonspecific findings. A negative radiograph also does not exclude the diagnosis of chronic mesenteric ischemia [19,57,68].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

“…MRA has become increasingly accurate in depicting and grading stenosis of the mesenteric vessels, particularly for the celiac artery and SMA, with reported sensitivity and specificity in suspected chronic mesenteric ischemia up to 95% to 100% [44][45][46][47]. Although MRA performs well in grading mesenteric vessel stenosis compared to DSA, accuracy and interobserver agreement may be lower compared to CTA [68]. Obtaining high-resolution angiograms reliably remains challenging, with the relatively lower resolution compared to CTA potentially limiting evaluation of distal branches and the inferior mesenteric artery [70].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

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ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia

Ginsburg

Obara

Lambert

et al. 2018

Journal of the American College of Radiology

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Mesenteric ischemia is an uncommon condition resulting from decreased blood flow to the small or large bowel in an acute or chronic setting. Acute ischemia is associated with high rates of morbidity and mortality; however, it is difficult to diagnose clinically. Therefore, a high degree of suspicion and prompt imaging evaluation are necessary. Chronic mesenteric ischemia is less common and typically caused by atherosclerotic occlusion or severe stenosis of at least two of the main mesenteric vessels. While several imaging examination options are available for the initial evaluation of both acute and chronic mesenteric ischemia, CTA of the abdomen and pelvis is overall the most appropriate choice for both conditions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia

Ginsburg

Obara

Lambert

et al. 2018

Journal of the American College of Radiology

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“…The degree to which the colonic blood flow may decrease before ischemia is variable and depends on the severity of the trigger event, the presence and, if present, the type of collateral vascularization and on the duration of low blood flow [ 1 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

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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“…The IMA occlusion is detected at enhanced CT as luminal defect [ 28 ]. Hypertension, diabetes mellitus, ischemic heart disease, congestive heart disease, age, and hyperlipidemia are known risk factors [ 29 ], as well as renal failure [ 9 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis

Iacobellis

Berritto

Fleischmann

et al. 2014

BioMed Research International

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Purpose. This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC), in correlation with the etiology and the different phases of the disease. Materials and Methods. CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic). Results. Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA), whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases), and it was never found in chronic phase, when the colon appeared irregularly thickened. Conclusion. CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damage.

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Ischemic Colitis

Cited by 20 publications

References 25 publications

ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia

ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia

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

CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis

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