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

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 unintentional damage to the artery supplying the colon
History of stroke
Low blood pressure
Congestive heart failure
Diabetes
Abdominal radiation exposure

Symptoms: Abdominal pain, Fever, Vomiting, Bright red blood in the stool and Diarrhea

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 (areas of narrowed colon) 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.

Ischemic colitis is a condition where the colon becomes inflamed or injured. The main cause of the inflammation is the decline in the blood flow to the colon, which can interfere with the colon's normal functions. Ischemic colitis can either be short-term or long-term, and severe cases can be life-threatening. The disease is also known as colonic ischemia.

Causes

The most frequent cause to the reduced blood supply to the colon is the presence of a blood clot, which blocks the arteries that supply the colon. Chronic cases have been associated with the build-up of fatty acids in the blood vessels leading to the colon, which can also cause a blockage. Other causes may be

inflammation of the blood vessels.
the presence of a hernia which can protrude into the surrounding organs and tissues and interfere with arterial and venous blood supply.
diabetes mellitus.
easy blood clotting.
radiation treatments to the abdomen.

Symptoms

The most common symptoms of ischemic colitis are abdominal pain, fever, vomiting, blood in the stools and diarrhea. Abdominal pain is often described a cramping pain located over the lower left side of the abdomen.

The urgency to defecate may also be felt by some. Examination of the colon through a colonoscopy will reveal inflamed intestinal mucosa or ulcerative lesions, while an angiography, which is a test that uses dyes and x-rays to visualize the arteries, will often shows lesions in the blood vessels.

Diagnostic Tests

Because ischemic colitis may present with signs and symptoms that are found in other disease like colon cancer, diverticulitis and colon cancer, it is important to rule out these diseases first before a sound diagnosis for ischemic colitis can be made. A colonoscopy or flexible sigmoidoscopy, is often the first test of choice with a person who presents the symptoms of ischemic colitis. This will often reveal the appearance of inflamed mucosa distinct to ulcerative colitis. It can also provide an alternate diagnosis, like an inflammatory bowel disease or infection. Biopsies can also provide more diagnostic information.

CT scans may be useful in the evaluation of bleeding and rectal pain, reveal the presence of complications and suggest an alternate diagnosis. Blood tests may reveal elevated white blood cell counts which are indicative of an infection while stools samples may reveal blood and bacteria associated with ischemic colitis.

Treatment

For mild and transient cases, the main treatment is the maintenance of normal blood pressure levels, which is often done with antihypertensive and diuretics. Patients are often advised to avoid food for the duration of the symptoms. To prevent dehydration, patients are advised to take adequate amounts of fluids. Antibiotics may be given to prevent or treat infection.

Chronic ischemic colitis is treated with surgery to remove the stricture and remove affected portions o of the intestine in a procedure called a laparotomy and bowel resection. Patients are often placed on bed rest and IV fluid therapy to prevent dehydration. Cardiac function and oxygenation need to be optimized in order to provide adequate oxygenation to the bowel. In cases of complications like gangrene and sepsis (infection in the blood) broad-spectrum antibiotics are often used, which or may not be accompanied by blood replacement and surgical removal of the diseased bowel.

Prognosis

Prognosis depends on the severity of the problem. Patients suffering from milder cases of ischemia often recover fully. However, patients with a pre-existing heart or blood vessel problem may be at a higher risk for developing complications which could lead to death.

Understanding Ischemic Colitis Recommended Resources:

University of Maryland Medical Center

Penn State Hershey Milton S. Hershey Medical Center