Advertisement

Digestive Diseases and Sciences

, Volume 54, Issue 9, pp 2009–2015 | Cite as

Endoscopic Findings and Clinicopathologic Characteristics of Ischemic Colitis: A Report of 85 Cases

  • Xiaoping Zou
  • Jun Cao
  • Yulin Yao
  • Wenjia Liu
  • Longdian Chen
Original Article

Abstract

Ischemic colitis is the most common type of intestinal ischemia and has a clinical spectrum of injury that ranges from mild and transient ischemia to acute fulminant colitis. The aim of this study was to explore endoscopic findings and clinicopathologic characteristics of ischemic colitis and be accurate enough to avoid missed diagnosis or misdiagnosis. A retrospective analysis was undertaken of endoscopy findings and clinicopathologic characteristics of 85 cases of ischemic colitis from March 2005 to April 2008 in the endoscopy center of our hospital. All cases underwent colonoscopy with biopsy within 2 weeks of the onset of symptoms, and all specimens with forceps were stained with hematoxylin–eosin and observed under light microscopy. Of the 85 cases of ischemic colitis (24 men and 61 women, average age 61.36 ± 14.49 years old, range 29–84), 71 were over 50 years of age. These cases were associated with the basal diseases such as hypertension, cardiovascular disorders, diabetes, and hematological diseases as well as a history of abdominal operation. The clinical features usually presented with sudden onset of abdominal pain, diarrhea, and hematochezia. Ischemic lesions were located mainly in the left colon with segmental form (only descending colon affected 16%, only splenic flexure 14%, and only sigmoid colon 23%). The 85 patients consisted of the non-gangrenous type (82), which were composed of reversible IC (76) and chronic IC (6), and the gangrenous type (3). Endoscopic appearance of the transient ischemic colitis consisted of petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement. Ischemic colitis of stricture was characterized by full-thickness mucosa, lumens stricture, and diseased haustrations. The mucosa of gangrenous colitis with cyanotic and pseudopolyps was endoscopically observed as well. Clinicopathologic characteristics showed mucosal inflammation accompanied by erosion, granulation tissue hyperplasia and gland atrophy, lamina propria hemorrhage, and macrophages with hemosiderin pigmentation in submucosa in particular. Although endoscopy findings and clinicopathologic characteristics of ischemic colitis are nonspecific, colonoscopy with biopsy plays a vital role in the early diagnosis of ischemic colitis.

Keywords

Ischemic colitis Endoscopy Clinicopathology 

Notes

Acknowledgment

We are grateful for good advice on pathology of ischemic colitis from Dr. LH Zhang from the pathology department in Gulou Hospital, Nanjing University, China.

References

  1. 1.
    Sreenarasimhaiah J. Diagnosis and management of intestinal ischemic disorders. BMJ. 2003;326:1372–1376. doi: 10.1136/bmj.326.7403.1372.PubMedCrossRefGoogle Scholar
  2. 2.
    Newman JR, Cooper MA. Lower gastrointestinal bleeding and ischemic colitis. Can J Gastroenterol. 2002;16:597–600.PubMedGoogle Scholar
  3. 3.
    Gandhi SK, Hanson MM, Vernava AM, et al. Ischemic colitis. Dis Colon Rectum. 1996;39:88–100. doi: 10.1007/BF02048275.PubMedCrossRefGoogle Scholar
  4. 4.
    MacDonald P. Ischaemic colitis. Best Pract Res Clin Gastroenterol. 2002;16:51–61. doi: 10.1053/bega.2001.0265.PubMedCrossRefGoogle Scholar
  5. 5.
    Greenwald DA, Brandt LJ. Colonic ischemia. J Clin Gastroenterol. 1998;27:122–128. doi: 10.1097/00004836-199809000-00004.PubMedCrossRefGoogle Scholar
  6. 6.
    Greenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:445–473. doi: 10.1016/S0889-8553(05)70190-4.PubMedCrossRefGoogle Scholar
  7. 7.
    Boley SJ, Schwartz S, Lash J, et al. Reversible vascular occlusion of the colon. Surg Crynecol Obstet. 1963;116:53–60.Google Scholar
  8. 8.
    Marston A, Pheils MT, Thomas ML, et al. Ischaemic colitis. Gut. 1966;7:1–15. doi: 10.1136/gut.7.1.1.PubMedCrossRefGoogle Scholar
  9. 9.
    Chang L, Kahler KH, Sarawate C, et al. Assessment of potential risk factors associated with ischaemic colitis. Neurogastroenterol Motil. 2008;20:36–42.PubMedGoogle Scholar
  10. 10.
    Higgins PD, Davis KJ, Laine L. Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther. 2004;19:729–738.PubMedCrossRefGoogle Scholar
  11. 11.
    Camilleri M. Is there an experimental basis for the development of ischaemic colitis as a result of 5-HT3 antagonist treatment? Neurogastroenterol Motil. 2007;19:77–84.PubMedCrossRefGoogle Scholar
  12. 12.
    Grundy D, Mclean P, Stead R. Impact of 5-HT3 receptor blockade on colonic haemodynamic responses to ischaemia and reperfusion in the rat. Neurogastroenterol Motil. 2007;19:607–616.PubMedCrossRefGoogle Scholar
  13. 13.
    Cole JA, Cook SF, Miller DP, et al. The risk of colonic ischemia among patients with irritable bowel syndrome. Dig Dis Week. 2002; A91 (abstract 726).Google Scholar
  14. 14.
    MacDonald PH. Ischaemic colitis. Pract Clin Gastroenterol. 2002;16:51–61.CrossRefGoogle Scholar
  15. 15.
    Brandt LJ, Bole SJ. Colonic ischemia. Surg Clin North Am. 1992;72:203–229.PubMedGoogle Scholar
  16. 16.
    Wolf EL, Sprayregen S, Bakal CW. Radiology in intestinal ischemia: plain film, contrast, and other imaging studies. Surg Clin North Am. 1992;72:107–124.PubMedGoogle Scholar
  17. 17.
    Philpotts LE, Heiken JP, Westcott MA, Gore RM. Colitis: use of CT findings in differential diagnosis. Radiology. 1994;190:445–449.PubMedGoogle Scholar
  18. 18.
    Iida M, Matsui T, Fuchigami T, et al. Ischemic colitis: serial changes in double–contrast barium enema examination. Radiology. 1986;159:337–341.PubMedGoogle Scholar
  19. 19.
    Sreenarasimhaiah J. Diagnosis and management of ischemic colitis. Curr Gastroenterol Rep. 2005;7:421–426.PubMedCrossRefGoogle Scholar
  20. 20.
    Bryan TG, David AT. Ischemic colitis: a clinical review. South Med J. 2005;98:217–222.CrossRefGoogle Scholar
  21. 21.
    Zuckerman GR, Prakash C, Merriman RB, et al. The colon single stripe sign and its relationship to ischemic colitis. Am J Gastroenterol. 2003;98:2018–2022.PubMedCrossRefGoogle Scholar
  22. 22.
    Scoweroft CW, Sanowski RA, Kozarek RA. Colonoscopy in ischemic colitis. Gastrointest Endosc. 1981;27:156–161.CrossRefGoogle Scholar
  23. 23.
    Favier C, Bonneau HP, Reboul F. Le diagnostic endoscopique descolites ischémiques régressives. A propos de 21 cas. End Dig. 1976;1:44–148.Google Scholar
  24. 24.
    Otttinger LW. Mesenteric ischemia. N Engl J Med. 1982;307:535–537.CrossRefGoogle Scholar
  25. 25.
    Rosenblum GD, Boyle CM, Schwartz LB. The mesenteric circulation: anatomy and physiology. Surg Clin North Am. 1997;77:289–306.PubMedCrossRefGoogle Scholar
  26. 26.
    Cappell MS. Intestinal (mesenteric) vasculopathy II. Gastroenterol Clin North Am. 1998;27:827–858.PubMedCrossRefGoogle Scholar
  27. 27.
    Rogers AI, David S. Intestinal blood flow and diseases of vascular impairment. In: Haubrich WS, Schaffner F, Berk JE, eds. Gastroenterology. 5th ed. Philadelphia: WB Saunders; 1995:1212–1223.Google Scholar
  28. 28.
    Mitsudo S, Brandt LJ. Pathology of intestinal ischemia. Surg Clin North Am. 1992;72:43–63.PubMedGoogle Scholar
  29. 29.
    Scharff JR, Longo WE, Vartanian SM, et al. Ischemic colitis: spectrum of disease and outcome. Surgery. 2003;134:624–630.PubMedCrossRefGoogle Scholar
  30. 30.
    Dignan CR, Greenson JK. Can ischemic colitis be differentiated from C difficile colitis by biopsy specimens? Am J Surg Pathol. 1997;21:706–710.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Xiaoping Zou
    • 1
  • Jun Cao
    • 1
  • Yulin Yao
    • 1
  • Wenjia Liu
    • 1
  • Longdian Chen
    • 1
  1. 1.Department of GastroenterologyNanjing Gulou Hospital Affiliated to Medical School of Nanjing UniversityNanjingPeople’s Republic of China

Personalised recommendations