Colitis pp 189-197 | Cite as

Ischemic Colitis

  • Peter Van Eyken
  • Daniela Fanni
  • Olivier Dewit
  • Karel Geboes


The large bowel accounts for roughly half of all episodes of gastrointestinal ischemia. The extent of damage to the colon will depend on the duration and cause of ischemic injury, the involved blood vessel type and its localization, as well as the possibility of collateral vascular supply. Three major manifestations of ischemic injury to the colon can be distinguished: massive bowel infarction (gangrenous colitis), hemorrhagic enterocolitis, and ischemic colitis (non-gangrenous colitis). Ischemic colitis, usually due to subacute colonic ischemia, is the most common form. The disease can be reversible or irreversible. It affects mainly elderly, but younger patients can also show features of ischemic colitis in particular situations. It occurs on the mucosal side (ulcero-inflammatory pattern) or transmural (cobblestoning and strictures). Histology shows a characteristic picture with variable cell necrosis, minimal inflammation, and hyalinization of the lamina propria.


Ischemia Ischemic colitis Reperfusion injury Bowel infarction Hemorrhagic enterocolitis Gangrenous colitis 


  1. 1.
    Brandt L, Feuerstadt P, Longstreth GF, Boley SJ. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015;110:18–44.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Doulberis M, Panagopoulos P, Scherz S, et al. Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit. Scand J Gastroenterol. 2016;51:893–902.CrossRefPubMedGoogle Scholar
  3. 3.
    Gandhi SK, Hanson MM, Vernava AM, et al. Ischemic colitis. Dis Colon Rectum. 1996;39:88–100.CrossRefPubMedGoogle Scholar
  4. 4.
    Habu Y, Tahashi Y, Kiyota K, et al. Reevaluation of clinical features of ischemic colitis. Analysis of 68 consecutive cases diagnosed by early colonoscopy. Scand J Gastroenterol. 1996;31:881–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Savoye G, Ben Soussan E, Hochain P, et al. Comment et jusqu’où explorer une colite ischémique? Gastroenterol Clin Biol. 2002;26:B12–23.PubMedGoogle Scholar
  6. 6.
    Parfitt JR, et al. Pathological effects of drugs on the gastrointestinal tract: a review. Hum Pathol. 2007;38:527–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Montgomery E, Riddell RH. Ischemic colitis in a young patient. Pathol Case Rev. 2004;9:93–6.CrossRefGoogle Scholar
  8. 8.
    Sanchez LD, Tracy JA, Berkhoff D, et al. Ischemic colitis in marathon runners: a case-based review. J Emerg Med. 2006;30:321–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Marston A, Pheils MT, Thomas ML, et al. Ischaemic colitis. Gut. 1996;7:1–15.CrossRefGoogle Scholar
  10. 10.
    Antolovic D, et al. Ischemic colitis analysis of risk factors for postoperative mortality. Langenbeck's Arch Surg. 2008;393:507–12.CrossRefGoogle Scholar
  11. 11.
    Trotter JM, Hunt L, Peter MB. Ischaemic colitis. BMJ. 2016;22:355.Google Scholar
  12. 12.
    Khor TS, Lauwers GY, Odze RD, Srivastava A. “Mass forming” variant of ischemic colitis is a distinct entity with predilection for the proximal colon. Am J Surg Pathol. 2015;39:1275–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Nahon S, Dugue C, Adotti F, et al. Small bowel obstruction secondary to ischemic stenosis due to cholesterol crystal embolism. Ann Med Interne. 2000;151:417–20.Google Scholar
  14. 14.
    Dignon CR, Greenson JK. Can ischemic colitis be differentiated from C. difficile colitis in biopsy specimens? Am J Surg Pathol. 1997;21:706–10.CrossRefGoogle Scholar
  15. 15.
    Whitehead R. The pathology of intestinal ischaemia. Clin Gastroenterol. 1972;1:613–37.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Peter Van Eyken
    • 1
  • Daniela Fanni
    • 2
  • Olivier Dewit
    • 3
  • Karel Geboes
    • 4
    • 5
  1. 1.Department of PathologyZiekenhuis Oost-Limburg ZOLGenkBelgium
  2. 2.Division of Pathology, Department of Surgical SciencesUniversity Hospital San Giovanni di Dio, University of CagliariCagliariItaly
  3. 3.Department of GastroenterologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  4. 4.Department of PathologyGhent University HospitalGhentBelgium
  5. 5.Department of PathologyKU LeuvenLeuvenBelgium

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