Ischemic colitis

Definition

Ischemic colitis is a sudden swelling (inflammation) of a part of the large intestine (colon) that occurs when there is a temporary loss of, or reduction in, blood flow to the colon.

Alternative Names

Colonic ischemia

Causes, incidence, and risk factors

Ischemic colitis mainly affects people over 50. Many of them have a history of peripheral vascular disease.

Other risk factors include:

• Congestive heart failure
• Diabetes
• History of stroke
• Low blood pressure
• Previous aortic surgery with unintentional damage to the artery supplying the colon
• Radiation to the abdomen

Symptoms

• Abdominal pain
• Bright red blood in the stool
• Diarrhea
• Fever
• Vomiting

Signs and tests

• Angiography
• Colonoscopy or flexible sigmoidoscopy

Treatment

Mild, temporary ischemic colitis is treated by maintaining good blood pressure. This can be done with medicines and by avoiding dehydration. Antibiotics are sometimes used.

Chronic ischemic colitis leading to areas of narrowed colon (strictures) is treated by removing the narrowed areas with surgery.

Severe ischemic colitis that leads to gangrene is treated with:

• Antibiotics
• Replacement of blood volume
• Surgery to remove the affected bowel area

Expectations (prognosis)

Most cases of ischemic colitis are mild and will improve on their own. They do not need treatment.

The death rate is high when gangrene occurs because there is not enough blood supply.

Complications

• Gangrene of the bowel
• Hole in the intestine (perforation)
• Inflammation of the lining of the abdomen (peritonitis)
• Sepsis

Calling your health care provider

Call your health care provider if you develop symptoms of ischemic colitis.

Prevention

Being aware of your risk may allow early diagnosis and treatment. Absolute prevention may not be possible.

References

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 146.