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Ischemic colitis


Alternative names

Acute interstitial ischemia

Definition

Ischemic colitis involves an area of inflammation (irritation and swelling with presence of extra immune cells) caused by interference with the blood flow to the large intestine.

Causes, incidence, and risk factors

Interference with blood flow to the colon is the cause of ischemic colitis. The disorder mainly affects people over 50, many of whom have a history of peripheral vascular disease . Other risk factors include previous aortic surgery with inadvertent damage to the artery supplying the colon; history of stroke , low blood pressure , congestive heart failure, or diabetes; and abdominal radiation exposure.

Symptoms

  • Abdominal pain
  • Fever
  • Vomiting
  • Bright red blood via the rectum ( blood in the stool )
  • Diarrhea
  • Back pain, low

Signs and tests

  • Colonoscopy with biopsy showing intestinal ischemia
  • Flexible sigmoidoscopy with biopsy showing intestinal ischemia
  • Angiography that shows a vascular (blood vessel) lesion

Treatment

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

Chronic ischemic colitis leading to stricture formation is treated by surgical removal of the stricture.

Severe ischemic colitis leading to gangrene is treated with replacement of blood volume, antibiotics, and surgical removal of the affected bowel area.

Expectations (prognosis)

The death rate is high when gangrene occurs as a result of inadequate blood supply.

Complications

  • Gangrene of the bowel
  • Perforation (hole in the intestine)
  • Peritonitis (inflammation of the lining of the abdomen)
  • Sepsis

Calling your health care provider

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

Prevention

Awareness of risk may allow early diagnosis and treatment. Absolute prevention may not be possible.

Update Date: 4/25/2002

Andrew J. Muir, M.D. M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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