Intestinal Ischemia

  • Hazar Michael
  • C. S. Pitchumoni
  • C. S. Pitchumoni
  • C. S. Pitchumoni


The prevalence of intestinal ischemia in the elder is higher than the general population and that largely due to increased atherosclerosis and heart diseases with aging. The two major types of intestinal ischemia are ischemic colitis and mesenteric ischemia. Ischemic colitis is a well-known complication of abdominal aortic aneurysm repair, both in elective and emergent cases. Acute mesenteric ischemia presents with abdominal pain and early on, prior to infraction, relatively benign abdominal examination. Mortality rate is high in all forms of mesenteric ischemia and early recognition and intervention prior to bowel infraction have the most impact on the prognosis. Chronic mesenteric ischemia is the least common form of all intestinal ischemia. Patient early on has postprandial abdominal pain and fear of eating leading to substantial weight loss and later on the pain may occur even in the fasting state. Rapid improvement in diagnostic and radiologic testing will likely have a positive impact on all forms of intestinal ischemia.


Superior Mesenteric Artery Abdominal Aortic Aneurysm Abdominal Aortic Aneurysm Inferior Mesenteric Artery Mesenteric Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cangemi JR, Picco MF. Intestinal ischemia in the elderly. Gastroenterol Clin North Am. 2009;38:527–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Lewiss RE, Egan DJ, Shreves A. Vascular abdominal emergencies. Emerg Med Clin North Am. 2011;29:253–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Vitin AA, Metzner JI. Anesthetic management of acute mesenteric ischemia in elderly patients. Anesthesiol Clin. 2009;27:551–67.PubMedCrossRefGoogle Scholar
  4. 4.
    Stamatakos M, Douzinas E, Stefanaki C, et al. Ischemic colitis: surging waves of update. Tohoku J Exp Med. 2009;218:83–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Brandt LJ, Feuerstadt P. Intestinal ischemia. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 9th ed. Philadelphia: W.B. Saunders; 2010: Chapter 114, electronic book.Google Scholar
  6. 6.
    Greenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:445–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Ozden N, Gurses B. Mesenteric ischemia in the elderly. Clin Geriatr Med. 2007;23:871–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Huerta C, Rivero E, Montoro MA, et al. Risk factors for intestinal ischemia among patients registered in a UK primary care database: a nested case-control study. Aliment Pharmacol Ther. 2011;33:969–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Okuyama Y, Kawakami T, Ito H, et al. A case of ischemic duodenitis associated with superior mesenteric artery syndrome caused by an abdominal aortic aneurysm. Case Rep Gastroenterol. 2011;5:278–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Boley SJ, Schwartz S, Lash J, et al. Reversible vascular occlusion of the colon. Surg Gynecol Obstet. 1963;116:53–60.PubMedGoogle Scholar
  11. 11.
    Theodoropoulou A, Koutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol. 2008;14:7302–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Sreenarasimhaiah J. Diagnosis and management of ischemic colitis. Curr Gastroenterol Rep. 2005;7:421–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Higgins PD, Davis KJ, Laine L. Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther. 2004;19:729–38.PubMedCrossRefGoogle Scholar
  14. 14.
    Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology. 2000;118:954–68.PubMedCrossRefGoogle Scholar
  15. 15.
    Montoro MA, Brandt LJ, Santolaria S, et al. Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study). Scand J Gastroenterol. 2011;46:236–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Dong Q, Wang Q, Li Y. Ischemic colitis after colonoscopy in a female patient. Am J Gastroenterol. 2009;104:2123–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Kao KT, Jain A, Sheinbaum A. Ischemic colitis following routine screening colonoscopy: a case report. Endoscopy. 2009;41 Suppl 2:E100.PubMedCrossRefGoogle Scholar
  18. 18.
    Becquemin JP, Majewski M, Fermani N, et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. Vasc Surg. 2008;47:258–63.CrossRefGoogle Scholar
  19. 19.
    Miller A, Marotta M, Scordi-Bello I, et al. Ischemic colitis after endovascular aortoiliac aneurysm repair: a 10-year retrospective study. Arch Surg. 2009;144:900–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Michael H, Brandt LJ, Hochsztein JG. Ischemic colitis complicating aortic dissection. Gastrointest Endosc. 2002;55:442–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Baixauli J, kiran RP, Delaney CP. Investigation and management of ischemic colitis. Cleve Clin J Med. 2003;70(11):920–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Elder K, Lashner BA, Al Solaiman F. Clinical approach to colonic ischemia. Cleve Clin J Med. 2009;76:401–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Halligan MS, Saunders BP, Thomas BM, et al. Ischaemic colitis in association with sigmoid carcinoma: a report of two cases. Clin Radiol. 1994;49:183–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Testini M, Marzaioli R, Gurrado A, et al. Massive mesenteric ischemia resulting from a giant strangulated umbilical hernia. Int Surg. 2007;92:296–9.PubMedGoogle Scholar
  25. 25.
    Punnam SR, Pothula VR, Gourineni N, et al. Interferon-ribavirin-associated ischemic colitis. J Clin Gastroenterol. 2008;42:323–5.PubMedGoogle Scholar
  26. 26.
    Dowd J, Bailey D, Moussa K, et al. Ischemic colitis associated with pseudoephedrine: four cases. Am J Gastroenterol. 1999;94:2430–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Kingsley DD, Schermer CR, Jamal MM. Rare complications of endoscopic retrograde cholangiopancreatography: two case reports. JSLS. 2001;5:171–3.PubMedGoogle Scholar
  28. 28.
    Krause R, Ameen V, Gordon SH, et al. A randomized, double-blind, placebo-controlled study to assess efficacy and safety of 0.5 mg and 1 mg alosetron in women with severe diarrhea-predominant IBS. Am J Gastroenterol. 2007;102:1709–19.PubMedCrossRefGoogle Scholar
  29. 29.
    Lewis JH. The risk of ischaemic colitis in irritable bowel syndrome patients treated with serotonergic therapies. Drug Saf. 2011;34:545–65.PubMedCrossRefGoogle Scholar
  30. 30.
    Brandt LJ, Feuerstadt P, Blaszka MC. Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol. 2010;105:2245–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Sotiriadis J, Brandt LJ, Behin DS, et al. Ischemic colitis has a worse prognosis when isolated to the right side of the colon. Am J Gastroenterol. 2007;102:2247–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Longstreth GF, Yao JF. Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia. Clin Gastroenterol Hepatol. 2009;7:1075–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Ahn SE, Lee HL, Cho SC, et al. Is end stage renal disease a poor prognosis factor of ischemic colitis? Korean J Gastroenterol. 2009;53:235–8.PubMedGoogle Scholar
  34. 34.
    Paterno F, McGillicuddy EA, Schuster KM, et al. Ischemic colitis: risk factors for eventual surgery. Am J Surg. 2010;200:646–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Reissfelder C, Sweiti H, Antolovic D, et al. Ischemic colitis: who will survive? Surgery. 2001;149:585–92.CrossRefGoogle Scholar
  36. 36.
    Serralta de Colsa D, Arjona Medina I, García-Marín A, et al. Predictive factors of mortality in severe ischaemic colitis: post-operative analysis of 101 patients. Cir Esp. 2009;85:348–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Ritz JP, Runkel N, Berger G, et al. Prognostic factors in mesenteric infarct. Zentralbl Chir. 1997;122:332–8.PubMedGoogle Scholar
  38. 38.
    Martinez JP, Hogan GJ. Mesenteric ischemia. Emerg Med Clin North Am. 2004;22:909–28.PubMedCrossRefGoogle Scholar
  39. 39.
    Burns BJ, Brandt LJ. Intestinal ischemia. Gastroenterol Clin North Am. 2003;32:1127–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Abu-Daff S, Abu-Daff N, Al-shahed M. Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up. J Gastrointest Surg. 2009;13:1245–50.PubMedCrossRefGoogle Scholar
  41. 41.
    Barajas Jr RF, Yeh BM, Webb EM, et al. Spectrum of CT findings in patients with atrial fibrillation and nontraumatic acute abdomen. AJR Am J Roentgenol. 2009;193:485–92.PubMedCrossRefGoogle Scholar
  42. 42.
    Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34:345–57.PubMedCrossRefGoogle Scholar
  43. 43.
    Moschetta M, Stabile Ianora AA, Pedote P, et al. Prognostic value of multidetector computed tomography in bowel infarction. Radiol Med. 2009;114:780–91.PubMedCrossRefGoogle Scholar
  44. 44.
    Schoots IG, Levi MM, Reekers JA, et al. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16:317–29.PubMedCrossRefGoogle Scholar
  45. 45.
    Arthurs ZM, Titus J, Bannazadeh M, et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg. 2011;53:698–705.PubMedCrossRefGoogle Scholar
  46. 46.
    Cenedese A, Monneuse O, Gruner L, et al. Initial management of extensive mesenteric venous thrombosis: retrospective study of nine cases. World J Surg. 2009;33:2203–8.PubMedCrossRefGoogle Scholar
  47. 47.
    White CJ. Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis. 2011;54:36–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Hansen KJ, Wilson DB, Craven TE. Mesenteric artery disease in the elderly. J Vasc Surg. 2004;40:45–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Zeller T, Macharzina R. Management of chronic atherosclerotic mesenteric ischemia. Vasa. 2011;40:99–107.PubMedCrossRefGoogle Scholar
  50. 50.
    Zeller T, Rastan A, Sixt S. Chronic atherosclerotic mesenteric ischemia (CMI). Vasc Med. 2010;15:333–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Daliri A, Grunwald C, Jobst B, et al. Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: is stenting superior to balloon angioplasty? Vasa. 2010;39:319–24.PubMedCrossRefGoogle Scholar
  52. 52.
    Gupta PK, Horan SM, Turaga KK, et al. Chronic mesenteric ischemia: endovascular versus open revascularization. J Endovasc Ther. 2010;17:540–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Hazar Michael
    • 1
  • C. S. Pitchumoni
    • 2
  • C. S. Pitchumoni
    • 3
  • C. S. Pitchumoni
    • 4
  1. 1.Department of MedicineUMDNJ-RWJMSNew BrunswickUSA
  2. 2.Robert Wood Johnson School of Medicine, Drexel University School of MedicinePhiladelphiaUSA
  3. 3.New York Medical CollegeVallhalaUSA
  4. 4.Gastroenterology, Hepatology and NutritionSaint Peter’s University HospitalNew BrunswickUSA

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