Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit

Abstract

Ischemic colitis is the result of colonic hypoperfusion and is regarded as a relatively rare condition. It can be roughly classified as occlusive and non-occlusive. Pathogenesis includes a usually transient compromise in the colonic vasculature, with a parallel activation of an inflammatory cascade caused primarily by reperfusion. Diagnosis of ischemic colitis remains often difficult and requires a combination of diagnostic techniques, whereas clinical signs are occasionally only seen late as complications. Gold standard is considered to be colonoscopy. Clinical presentation and treatment of ischemic colitis vary widely depending on the degree of ischemia. Patients of intensive care unit (ICU) with ischemic colitis are often under-diagnosed, since the parallel co-morbidities and the nonspecific nature of symptoms that mimic almost any abdominal pathology, can mislead the doctor. Moreover, sedated or ventilated patients can mask many of the characteristic features of ischemic colitis and make the diagnosis challenging. Bedside colonoscopy and diagnostic laparoscopy in ICUs are two options, which seem lately to be reliable and promising in diagnosing ischemic colitis in critically ill patients.

Polydeoxyribonucleotide Exerts Therapeutic Effect by Increasing VEGF and Inhibiting Inflammatory Cytokines in Ischemic Colitis Rats

“…Ischemic colitis, the most common ischemic pathology of the gastrointestinal tract, generally results from an inadequate blood supply to a segment of the colon or the entire colon and leading to colonic inflammation and necrosis [1]. Although the incidence of ischemic colitis in the general population is likely underestimated because many cases are misdiagnosed as inflammatory bowel disease, the annual incidence is estimated at 4.5 to 44 cases per 100,000 persons [2,3].…”

“…e clinical treatment for ischemic colitis varies widely depending on the cause and degree of ischemia. Although there are various etiologies of ischemic colitis, which are unidentified in most cases, the important underlying mechanism is ischemia [1]. e colon is susceptible to ischemia due to its anatomical and physiological features, including relatively low blood flow and less-developed microvasculature plexus compared to the rest of the gastrointestinal system [5].…”

Ischemic colitis problems of diagnosis and treatment

“…Angiography and nuclear medicine (In-111 label leukocyte scans) were rarely helpful in diagnosis of ischemic colitis. Patients with ischemic colitis are often under-diagnosed and gold standard is considered to be colonoscopy [17].…”

Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon

“…A detailed inquiry about the patient’s medical history, including use of natural supplements or medications taken without physician recommendation or supervision, revealed a history of taking compound Qingdai pills before the onset of the disease. Various examinations made to determine the etiology of colonic stenosis pinpointed the differential diagnosis between ischemic bowel disease[9] and IBD[10]. Although it has been reported that compound Qingdai pills have a therapeutic effect on ulcerative colitis[11,12], colonic mucosal injury caused by compound Qingdai pills has also been reported[13].…”

“…Therefore, metallic stenting is relatively contraindicated in patients with benign stenosis[18-20]. In the present case, however, stent placement was performed for the purpose of preoperative bowel preparation, and it relieved the incomplete intestinal obstruction, reduced the intestinal wall edema, and created the conditions necessary for examining the terminal ileum and the whole colon; ultimately, the stenting helped rule out the possibility of the presence of lesions in other parts of the colon and the possibility of CD preoperatively[21,22], providing a diagnostic basis for the subsequent surgical treatment[9,23,24]. …”