Ischaemic Colitis

  • A. B. Price
Part of the Current Topics in Pathology book series (CT PATHOLOGY, volume 81)


In a retrospective study of 81 patients presenting with colitis after the age of 50 years, ischaemic colitis was diagnosed in 75%, one-half of whom had an original discharge diagnosis of ulcerative colitis or Crohn’s disease. The authors (Brandt et al. 1981) claimed ischaemic colitis is the commonest cause of colitis in this age group. Whether or not this is the case, ischaemic bowel disease is an underdiagnosed entity. It is clearly important for the pathologist to recognise the basic patterns of ischaemic bowel disease and not to overdiagnose Crohn’s disease and ulcerative colitis with their consequent major clinical and social implications. Recognition of ischaemic damage in a biopsy will direct the clinician’s attention to investigate the vascular system, either the major vessels, or, in the correct setting, causes of systemic vasculitis. Drugs may be implicated in some cases (Riddell 1982), as may mechanical factors such as mucosal prolapse (DU Boulay et al. 1983). Ischaemia has always been thought to play a role in severe bowel infections, in particular those due to Clostridia spp., via the vasoconstrictive effects of released bacterial toxins (Marston 1977). Ischaemia therefore envelops a wide spectrum of disease entities in which the basic event is an insufficient blood supply for the needs of the mucosa.


Ulcerative Colitis Lamina Propria Pseudomembranous Colitis Collagenous Colitis Mucosal Prolapse 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. AlschibajaT, Morson BC (1977) Ischaemic bowel disease. J Clin Pathol 30 [Suppl 11]:68–77CrossRefGoogle Scholar
  2. Barcewicz PA, Welch JP (1980) Ischaemic colitis in young patients. Dis Colon Rectum 123:109–114CrossRefGoogle Scholar
  3. Bartlett JG, Moon N, Chang TW, Taylor N, Oderdonk AB (1978) Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. Gastroenterology 75:778–782PubMedGoogle Scholar
  4. Berthrong M, Fajardo LF (1981) Radiation injury in surgical pathology. Part II. Alimentary tract. Am J Surg Pathol 5:153–178PubMedCrossRefGoogle Scholar
  5. Binns JC, Isaacson P (1978) Age-related changes in colonic blood supply. Their relevance to ischaemic colitis. Gut 19:384–390PubMedCrossRefGoogle Scholar
  6. Bogomoletz MV, Adnet JJ, Birembaut P, Feydy P, Dupont P (1980) Collagenous colitis: an unrecognised entity. Gut 21:164–169PubMedCrossRefGoogle Scholar
  7. Brandt L, Boley S, Goldberg L, Mitsudo S, Berman A (1981) Colitis in the elderly. Am J Gastroenterol 76:239–245PubMedGoogle Scholar
  8. Camilleri M, Pusey CD, Chadwick VS, Rees AJ (1983) Gastroinestinal manifestations of systemic vasculitis. Q J Med 52:141–149PubMedGoogle Scholar
  9. Cotton PB, Thomas ML (1971) Ischaemic colitis and the contraceptive pill. Br Med J 3:27–28PubMedGoogle Scholar
  10. Croft RJ, Menon GP, Marston A (1981) Does intestinal angina exist? A critical study of obstructed visceral arteries. Br J Surg 68:316–318PubMedCrossRefGoogle Scholar
  11. Darsee JR (1979) Cholesterol embolism: the great masquerader. South Med J 72:174–180PubMedCrossRefGoogle Scholar
  12. Dawson MA, Schaefer JW (1971) The clinical course of reversible ischaemic colitis — observations on the progression of sigmoidoscopic and histological changes. Gastroenterology 60:577–580PubMedGoogle Scholar
  13. Devroede G, Vobecky S, Masse S, Arhan P, Leger C, Duguay C, Hemond M (1982) Ischaemic fecal incontinence and rectal angina. Gastroenterology 83:970–980PubMedGoogle Scholar
  14. Dick AP, Graff R, Gregg D, Peters N, Sarner M (1967) An arteriographic study of mesenteric arterial disease. 1. Large vessel changes. Gut 8:206–220PubMedCrossRefGoogle Scholar
  15. du Boulay CEH, Fairbrother J, Isaacson PG (1983) Mucosal prolapse syndrome — a unifying concept for solitary ulcer syndrome and related disorders. J Clin Pathol 36: 1264–1268PubMedCrossRefGoogle Scholar
  16. Feldman PS (1975) Ulcerative disease of the colon proximal to partially obstructive lesions. Dis Colon Rectum 18:601–612PubMedCrossRefGoogle Scholar
  17. Gekas P, Schuster AM (1981) Stercoral perforation of the colon: case report and review of the literature. Gastroenterology 80:1054–1058PubMedGoogle Scholar
  18. Hasleton PS, Carr N, Schofield PF (1985) Vascular changes in radiation bowel disease. Histopathology 9:517–534PubMedCrossRefGoogle Scholar
  19. Hay AM (1978) Association between chlorpromazine therapy and necrotizing colitis. Dis Colon Rectum 21:380–382PubMedCrossRefGoogle Scholar
  20. Helliwell TR, Flook D, Whitworth J, Day DW (1985) Arteritis and venulitis in systemic lupus erythematosus resulting in massive lower intestinal haemorrhage. Histopathology 9:1103–1113PubMedCrossRefGoogle Scholar
  21. Heron HC. Khubchandani IT, Trimpi HD, Sheets JA, Starik JJ (1981) Evanescent colitis. Dis Colon Rectum 24:555–561PubMedCrossRefGoogle Scholar
  22. Kingham JGC, Levison DA, Morson BC, Dawson AM (1986) Collagenous colitis. Gut 27:570–577PubMedCrossRefGoogle Scholar
  23. Knutson H, Lunderquist A, Lundcrquist A (1968) Vascular changes in Crohn’s disease. AJR 103:380–385Google Scholar
  24. Kumar PJ, Dawson AM ( 1972) Vasculitis of the alimentary tract. Clin Gastroenterol 1:719–743Google Scholar
  25. Larson HE. Price AB (1977) Pseudomembranous colitis: presence of clostridial toxin. Lancet II: 1312–1314CrossRefGoogle Scholar
  26. Lee RG (1986) The colitis of Behçct’s syndrome. Am J Surg Pathol 10:888–893PubMedCrossRefGoogle Scholar
  27. Lobert PE Appelman HD (1981) Inflammatory cloacogcnic polyps. A unique inflammatory lesion of the anal transitional zone. Am J Surg Pathol 5:761–766PubMedCrossRefGoogle Scholar
  28. Margarcttcn W, McKay DG (1971) Thrombotic ulcerations of the gastrointestinal tract. Arch Intern Med 127:250–253CrossRefGoogle Scholar
  29. Marston A (1977) Intestinal ischacmia. Edward Arnold, London, p 81Google Scholar
  30. Marston A (1986) Vascular disease of the gut. Edward Arnold, London, pp 1–15Google Scholar
  31. Marston A, Pheils MT, Lea Thomas, Morson BC (1966) Ischaemic colitis. Gut 7:1–15PubMedCrossRefGoogle Scholar
  32. May GM, De Weese JA, Rob CG (1963) Hacmodynamic effects of arterial stenosis. Surgery 53:513–524PubMedGoogle Scholar
  33. Miller WT, De Poto DW, Scholl HW, Rattensperger EC (1971) Evanescent colitis in the young adult: a new entity? Radiology 100:71–78PubMedGoogle Scholar
  34. O’Connell DJ, Courtney JV, Riddell RH (1980) Colitis of Behçet’s syndrome - radiologic and pathologic features. Gastronintest Radiol 5:173–179CrossRefGoogle Scholar
  35. Price AB, Davies DRD (1977) Pseudomembranous colitis. J Clin Pathol 30:1–12PubMedCrossRefGoogle Scholar
  36. Price AB, Jewkes J, Sanderson PJ (1979) Acute diarrhoea Campylobacter colitis and the role of rectal biopsy. J Clin Pathol 32:990–997PubMedCrossRefGoogle Scholar
  37. Reeders JWAJ, Tytgat GNJ, Rosenbusch G, Gratama S (1984) Ischaemic colitis. Martinus Nijhoff, BostonGoogle Scholar
  38. Renton CJC (1972) Non-occlusive intestinal infarction. Clin Gastroenterol 1:655–674Google Scholar
  39. Riddell RH (1982) The gastrointestinal tract. In: Riddell RM (ed) Pathology of drug induced and toxic diseases. Churchill Livingstone, Edinburgh, pp 516–520Google Scholar
  40. Rosen N, Sommer I, Knobel B (1985) Intestinal Buerger’s disease. Arch Pathol Lab Med 109:962–963PubMedGoogle Scholar
  41. Rutter KRP, Riddell RH (1975) The solitary ulcer syndrome of the rectum. Clin Gastroenterol 4:505–530PubMedGoogle Scholar
  42. Scowcroft CW, Sanowski RA, Kozarek RA (1981) Colonoscopy in ischaemic colitis. Gastrointest Endosc 27:156–161PubMedCrossRefGoogle Scholar
  43. Smith GE, Kime LR, Pitcher JL (1973) The colitis of Behçet’s disease: a separate entity? Colonoscopic findings and literature review. Am J Dig Dis 18:987–999PubMedCrossRefGoogle Scholar
  44. Talbot I, Price AB (1987) Biopsy pathology in colorectal disease. Chapman and Hall, LondonGoogle Scholar
  45. Tribe CR, Scott DGI, Bacon PA (1981) Rectal biopsy in the diagnosis of systemic vasculitis. J Clin Pathol 34:843–850PubMedCrossRefGoogle Scholar
  46. Whitehead R (1971) Ischaemic enterocolitis; an expression of the intravascular coagulation syndrome. Gut 12:912–917PubMedCrossRefGoogle Scholar
  47. Whitehead R (1976) The pathology of ischaemia of the intestines. Pathol Annu 11:1–52PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • A. B. Price

There are no affiliations available

Personalised recommendations