Fact-sheet: Ischemic colitis
Updated on 04/19/2018 at 3:59 PM
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Definition
Ischemic colonic disease, most often nonocclusive in origin, caused by colonic hypoperfusion resulting in variable degrees of wall hypoxia.
Clinical features
- Population: most often > 50 years old
- Mortality between 10 and 30%
- Risk factors: atheroma, atrial fibrillation, embolic disease, vasculitis, mechanical colonic obstruction, AAA surgery, coagulation disorders, low output states (cardiac...)
- Nongangrenous form (90%): abdominal pain, bloody diarrhea, rectal bleeding, hyperthermia
- Gangrenous form: guarding, septic shock, surgical emergency
Laboratory findings
- Leukocytosis
- Metabolic acidosis
- Renal failure
Radiography
- Plain abdominal radiograph: often unremarkable
- Contrast enema: thumbprinting pattern (obsolete)
Ultrasound
Wall thickening, target sign, peritoneal effusion
CT
Study of choice, with contrast injection. - Topography: segmental involvement, left colon 50% (pancolic 10%). Watershed areas (splenic flexure: Griffith's point, rectosigmoid junction: Sudeck's point) - Nongangrenous form: target-like wall thickening, submucosal edema, marked mucosal enhancement. Luminal narrowing. Small bowel spared. Pericolic fat infiltration - Gangrenous form: intramural pneumatosis. Mesenteric and/or portal venous gas. Complete transmural enhancement defect (virtual wall). Perilesional serohematic infiltration. Pneumoperitoneum
Management
Colonoscopy: - Submucosal edema, necrotic areas, ulcerations, petechiae - Confirms the diagnosis. Transient form: - Symptomatic and etiologic treatment (vascular risk factors). Antibiotic therapy. Severe form: - Surgery (extended colectomy)
Differential diagnosis
Infectious colitis:
- mildly bloody diarrhea
- involvement that may be pancolic
- marked inflammatory syndrome
- possible associated small bowel involvement
- recent antibiotic therapy context