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

Abstract

There are currently no guidelines on the long-term management of patients after an episode of acute ischaemic colitis. Our aim was to review the literature on the pattern of presentation and the pathophysiology of this condition and to understand the current status of the acute and long-term management of ischaemic colitis. Furthermore, we aim to provide recommendations for the clinicians in regard to the acute and long-term management of ischaemic colitis. A review of the English literature over the last 15 years was performed using Embase and Medline. Search terms were ischaemic OR ischemic, colitis OR colon. Two reviewers screened the papers against predetermined eligibility criteria. A senior consultant surgeon performed a final overview. Three hundred sixty-eight papers were identified on the initial search; 318 were irrelevant and 17 were conference abstracts; both were excluded. Thirty-three full articles were assessed for suitability; nine were further excluded. Twenty-four articles were included in the final analysis and cross-referenced against those listed in the systematic reviews. There is a large clinical heterogeneity in inclusion criteria (histological, radiological, endoscopic, surgical specimen). Twelve out of 24 articles included patients only based on histological diagnosis. The definition of right and left (or nonright) ischaemic colitis was variable based on whether hepatic or splenic flexure was used as the cut-off point. Five retrospective case series highlighted that patients with isolated right-sided ischaemic colitis had a worse prognosis than those with left-sided colitis (higher mortality, need for surgery, length of hospital stay). The overall recurrence was 9%. There is a need for a higher-level evidence to guide clinicians on the long-term management of patients following an episode of acute colonic ischaemia. Further evidence is required to determine whether right colonic ischaemia should be managed differently from left.

Factors influencing hospital stay duration for patients with mild ischemic colitis: a retrospective study

“…The results of this study reinforce the fact that the incidence of colonic ischemia is higher in female patients than in male patients, and IC is more common among older patients, as previously reported [ 8 , 13 ]. This might be attributed to older patients’ increased susceptibility to atherosclerosis, which is one of the postmenopausal changes that leads to alterations in the blood supply of the colon, with a great impact on the areas of the colon most vulnerable to ischemic insult [ 14 ]. Previous studies indicated that abdominal pain, hematochezia, and diarrhea are the most common symptoms of IC, which is nearly consistent with the results of our study, as abdominal pain and rectal bleeding were the most frequent symptoms at presentation, followed by decreased appetite, abdominal distension, and diarrhea.…”

Ischemic colitis in a patient with chronic kidney failure: case report

“…Regarding the clinical findings, patients can present abdominal tenderness, and, in severe cases, signs of acute peritonitis (abdominal distension, guarding and severe tenderness) 17 . Therefore, the triade formed by abdominal pain, tenderness and rectal bleeding represents the main presentation form 8 .…”

“…Mortality rate is considered around 15% 8 . Studies have shown that right colon ischemia or involvement of both right and left colon in patients with age over 50 years are associated with poor outcome 19 .…”

“…The duration of hypoperfusion is determinant for ischemia extension and overall outcome 2,3 , patients dependent on renal replacement therapies being at the highest risk, especially due to microvascular damages and periods of hypotension in relation with haemodialysis [4][5][6] . A study conducted by Yngvadottir et al 7 showed that the incidence of ischemic colitis is of 7.3 cases per 100,000 people, while Demetriou et al 8 support the fact that it can affect almost 18 per 100,000 of the population. It usually presents with unspecific warning symptoms or signs, like low abdominal pain, inferior gastrointestinal bleeding, especially rectal bleeding, ileus, fever, generalized peritonitis or shock 9 .…”

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

“…Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery [1], being associated with mortality rates of 50-80% [2,3]. IC represents the most common type of intestinal ischemia with an estimated incidence of 15.6-17.7/100,000 person-years [4].…”