Abstract
Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops “spontaneously,” in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis.
Similar content being viewed by others
References
Boley SJ, Schwartz S, Lash J, Sternhill V. Reversible vascular occlusion of the colon. Surg Gynecol Obstet 1963;116:53–60.
Martson A, Pheils MT, Thomas L, Morson BC. Ischemic colitis. Gut 1966;7:1–15.
Stamos MJ. Colonic ischemia. In: Mazier WP, Luchtefeld MA, Levien DH, Senagore AJ, eds. Surgery of the colon, rectum, and anus. WB Saunders, 1995:705–13.
Michels NA, Siddarth P, Kornblith PL, Parke WW. The variant blood supply to the descending colon, rectosigmoid, and rectum based on 400 dissections. Its importance in regional resections: a review of the literature. Dis Colon Rectum 1965;8:251–78.
Sonneland J, Anson B, Beaton L. Surgical anatomy of the arterial supply of the colon from the superior mesenteric artery based upon a study of 600 specimens. Surg Gynecol Obstet 1958;106:385–98.
Steward JA, Rankin FW. Blood supply of the large intestine: its surgical considerations. Arch Surg 1933;26:843–91.
Griffiths JD. Surgical anatomy of the blood supply of the distal colon. Ann R Coll Surg Engl 1956;19:241–56.
Fisher DF, Fry WJ. Collateral mesenteric circulation. Surg Gynecol Obstet 1959;108:641–50.
Harnsberger JR, Longo WE, Vernava AM. Vascular anatomy. Semin Colon Rectal Surg 1994;5:2–13.
Drummond H. Some points relating to the surgical anatomy of the arterial supply of the large intestine. J R Soc Med 1913;7:185–93.
Kornblith PL, Boley SJ, Whitehouse BS. Anatomy of the splanchnic circulation. Surg Clin North Am 1992;72:1–30.
Renton CJ. Massive intestinal infarction following multiple injury. Br J Surg 1967;54:399–402.
Young TB. Post-traumatic delayed rupture of the colon without identifiable cause. Injury 1985;16:327–30.
Trinh TD, Jones B, Fishman EK. Amyloidosis of the colon presenting as ischemic colitis: a case report and review of the literature. Gastrointest Radiol 1991;16:133–6.
Ho MS, Teh LB, Goh HS. Ischaemic colitis in systemic lupus erythematosus—report of a case and review of the literature. Ann Acad Med Singapore 1987;16:501–3.
Reissman P, Weiss EG, Teoh TA, Lucas FV, Wexner SD. Gangrenous ischemic colitis of the rectum: a rare complication of systemic lupus erythematosus. Am J Gastroenterol 1994;89:2234–6.
Kaminski DL, Herrmann VM. Ischemic colitis. In: Cameron J, ed. Current surgical therapy. 2nd ed. Toronto: BC Decker 1986:110–4.
Gurbuz AK, Gurbuz B, Sales L, Rosenshein NB, Donowitz M, Giardiello FM. Premarin-induced ischemic colitis. J Clin Gastroenterol 1994;19:108–11.
Miyata T, Tamechika Y, Torisu M. Ischemic colitis in a 33 year old woman on danazol treatment for endometriosis. Am J Gastroenterol 1988;83:1420–3.
Wright A, Benfield GF, Felix-Davies D. Ischaemic colitis and immune complexes during gold therapy for rheumatoid arthritis. Ann Rheum Dis 1984;43:495–7.
Carratu R, Parisi P, Agozzino A. Segmental ischemic colitis associated with nonsteroidal anti-inflammatory drugs. J Clin Gastroenterol 1993;16:31–4.
Larrey D, Lainey E, Blanc P,et al. Acute colitis associated with prolonged administration of neuroleptics. J Clin Gastroenterol 1992;14:64–7.
Bower TC. Ischemic colitis. Surg Clin North Am 1993;73:1037–53.
Glotzer DJ, Roth SI, Welch CE. Colonic ulceration proximal to obstructing carcinoma. Surgery 1964;56:950–6.
Halligan MS, Saunders P, Thomas BM, Phillips RK. Ischaemic colitis in association with sigmoid carcinoma: a report of two cases. Clin Radiol 1994;49:183–4.
Seow-Choen F, Chua TL, Goh HS. Ischaemic colitis and colorectal cancer: some problems and pitfalls. Int J Colorectal Dis 1993;8:210–2.
Mallet L, Verdier D. Should subdivision of regressive ischemic colitis be envisaged? Ann Gastroenterol Hepatol (Paris) 1992;28:194–8.
Williams LF, Wittenberg J. Ischemic colitis: a useful clinical diagnosis, but is it ischemic? Ann Surg 1975;182:439–48.
Kvietys PR, Granger DN. Regulation of colonic blood flow. Fed Proc 1982;41:2106–10.
Brandt LJ, Boley SJ. Nonocclusive mesenteric ischemia. Annu Rev Med 1991;42:107–17.
Douglas DM, Russell JC, Goren D, Dempsey S, Das DK. Evidence of free radical (FR) involvement in ischemic colitis. Agents Actions 1989;27:435–7.
Price AB. Ischaemic colitis. Curr Top Pathol 1990;81:229–46.
Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am 1992;72:203–29.
Boley SJ. Colonic ischemia—25 years later. Am J Gastroenterol 1990;85:931–4.
Fitzgerald SF, Kaminski DL. Ischemic colitis. Semin Colon Rectal Surg 1993;4:222–8.
Kaleya RN, Boley SJ. Colonic ischemia. Perspect Colon Rectal Surg 1990;3:62–81.
Reeders JW, Tytgat GN, Rosenbusch G, Gramata S. Ischemic colitis. The Hague: Martinus Nijoff, 1984: 17–28, 145–151.
Guttormson NL, Bubrick MP. Mortality from Ischemic colitis. Dis Colon Rectum 1989;32:469–72.
Landreneau RJ, Fry WJ. The right colon as a target organ of nonocclusive mesenteric ischemia. Arch Surg 1990;125:591–4.
Longo WE, Ballantyne GH, Gusberg RJ. Ischemic colitis: patterns and prognosis. Dis Colon Rectum 1992;35:726–30.
Boley SJ, Brandt LJ, Veith FJ. Ischemic disorders of the intestines. Curr Probl Surg 1978;15:53–7.
Schoetz DJ Jr. Ischemic colitis. Probl Gen Surg 1992;9:710–6.
Iida M, Matsui T, Fuchigami T, Iwashita A, Yao T, Fujishima M. Clinical features of nongangrenous ischemic colitis: a comparison of stricturing and transient forms. J Clin Gastroenterol 1986;8:635–9.
Barcewicz PA, Welch JP. Ischemic colitis in young adult patients. Dis Colon Rectum 1980;23:109–14.
Judge JS, Hoffman NE, Levitt MD. Transient ischemic colitis in young adults. Aust N Z J Surg 1994;64:721–2.
Gage TP, Gagnier JM. Ischemic colitis complicating sickle cell crisis. Gastroenterology 1983;84:171–4.
Beaumont AC, Teare JP. Subtotal colectomy following marathon running in a female patient. J R Soc Med 1991;84:439–40.
Heer M, Repond F, Hany A, Sulser H, Kehl O, Jager K. Acute ischaemic colitis in a female long distance runner. Gut 1987;28:896–9.
Brown DN, Rosenholtz MJ, Marshall JB. Ischemic colitis related to cocaine abuse. Am J Gastroenterol 1994;89:1158–61.
Scholz FJ. Ischemic bowel disease. Radiol Clin North Am 1993;31:1197–218.
Philpotts LE, Heiken JP, Westcott MA, Gore RM. Colitis: use of CT findings in differential diagnosis. Radiology 1994;190:445–9.
Ranschaert E, Verhille R, Marchal G, Rigauts H, Ponette E. Sonographic diagnosis of ischemic colitis. J Belge Radiol 1994;77:166–8.
Brandt LJ, Boley SJ, Sammartano RJ. Carbon dioxide and room air insufflation of the colon: effects on colonic blood flow and intraluminal pressure in the dog. Gastrointest Endosc 1986;32:324–9.
Wheeldon NM, Grundman MJ. Ischaemic colitis as a complication of colonoscopy. BMJ 1990;301:1080–1.
Schneider TA, Longo WE, Ure T, Vernava AM. Mesenteric ischemia. Dis Colon Rectum 1994;37:1163–74.
Prasad CN, Wade TP. Mesenteric venous thrombosis. Semin Colon Rectal Surg 1993;4:218–21.
Robert JH, Mentha G, Rohner A. Ischaemic colitis: two distinct patterns of severity. Gut 1993;34:4–6.
Herrmann VM, Keltner RM. Intraoperative assessment of intestinal viability. Semin Colon Rectal Surg 1994;4:198–204.
Fiddian-Green RG, Amelin PM, Herrmann JB,et al. Prediction of the development of sigmoid ischemia on the day of aortic operations. Arch Surg 1986;121:654–60.
Bergman RT, Gloviczki P, Welch TJ,et al. Role of intravenous fluorescein in detection of colon ischemia during aortic reconstruction. Ann Vasc Surg 1992;61:74–9.
West BR, Ray JE, Gathright JB. Comparison of transient ischemic colitis with that requiring surgical treatment. Surg Gynecol Obstet 1980;151:366–8.
Abel ME, Russell TR. Ischemic colitis: comparison of surgical and non-operative management. Dis Colon Rectum 1983;26:113–5.
Parish KL, Chapman WC, Williams LF. Ischemic colitis: an ever-changing spectrum? Am Surg 1991;57:118–21.
Barnett MG, Longo WE. Intestinal ischemia after aortic surgery. Semin Colon Rectal Surg 1993;4:229–34.
Launer DP, Miscall BG, Beil AB. Colorectal infarction following resection of abdominal aortic aneurysms. Dis Colon Rectum 1978;21:613–7.
Maupin GE, Rimar SD, Villalba M. Ischemic colitis following abdominal aortic reconstruction for ruptured aneurysm: a 10-year experience. Am Surg 1989;55:378–80.
Ottinger LW, Darling RC, Nathan MJ, Linton RR. Left colon ischemia complicating aorto-iliac reconstruction: causes, diagnosis, management and prevention. Arch Surg 1972;105:841–6.
Zelenock GB, Strodel WE, Knol JA,et al. A prospective study of clinically and endoscopically documented colonic ischemia in 100 patients undergoing aortic reconstructive surgery with aggressive colonic and direct pelvic revascularization, compared with historic controls. Surgery 1989;106:771–80.
Hagihara PF, Ernst CB, Griffen WO Jr. Incidence of ischemic colitis following abdominal aortic reconstruction. Surg Gynec Obstet 1979;149:571–3.
Meissner MH, Johansen KH. Colon infarction after ruptured abdominal aortic aneurysm. Arch Surg 1992;127:979–85.
Welling RE, Roedersheimer LR, Arbaugh JJ. Ischemic colitis following repair of ruptured abdominal aortic aneurysm. Arch Surg 1985;120:1368–70.
Seeger JM, Coe DA, Kaelin LD, Flynn TC. Routine reimplantation of patent inferior mesenteric arteries limits colon infarction after aortic reconstruction. J Vasc Surg 1992;15:635–41.
Willman VL. Intestinal ischemia after cardiopulmonary bypass. Semin Colon Rectal Surg 1993;4:235–9.
Allen KB, Salam AA, Lumsden AB. Acute mesenteric ischemia after cardiopulmonary bypass. J Vasc Surg 1992;16:391–6.
Gennaro M, Ascer E, Matano R, Jacobowitz IJ, Cunningham JN Jr, Uceda P. Acute mesenteric ischemia after cardiopulmonary bypass. Am J Surg 1993;166:231–6.
Huddy SP, Joyce WP, Pepper JR. Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery. Br J Surg 1991;78:293–6.
Mercado PD, Farid H, O'Connell TX, Sintek CF, Pfeffer T, Khonsari S. Gastrointestinal complications associated with cardiopulmonary bypass procedures. Am Surg 1994;60:789–92.
Welling RE, Rath R, Albers JE, Glaser RS. Gastrointestinal complications after cardiac surgery. Arch Surg 1986;121:1178–80.
Downing SW, Edmunds LH Jr. Release of vasoactive substances during cardiopulmonary bypass. Ann Thorac Surg 1992;4:291–6.
Moore RM, Bertone AL, Muir W, Stromberg PC, Beard WL. Histopathologic evidence of reperfusion injury in the large colon of horses after low-flow ischemia. Am J Vet Res 1994;55:1434–43.
Moore RM, Muir W, Bertone AL, Beard WL. Characterization of the hemodynamic and metabolic alterations in the large colon of horses during low-flow ischemia and reperfusion. Am J Vet Res 1994;55:1444–53.
Fiorito JJ, Schoen RE, Brandt LJ. Pseudo-obstruction associated with colonic ischemia: successful management with colonoscopic decompression. Am J Gastroenterol 1991;86:1472–6.
Scott B, Isbister WH. Ischaemic colitis as a complication of left-sided large bowel obstruction: a case report. Aust N Z J Surg 1991;61:73–5.
Welch GH, Shearer MG, Imrie CW, Anderson JR, Gilmour DG. Total colonic ischemia. Dis Colon Rectum 1986;29:410–2.
Author information
Authors and Affiliations
About this article
Cite this article
Gandhi, S.K., Hanson, M.M., Vernava, A.M. et al. Ischemic colitis. Dis Colon Rectum 39, 88–100 (1996). https://doi.org/10.1007/BF02048275
Issue Date:
DOI: https://doi.org/10.1007/BF02048275