Skip to main content
SpringerLink
Log in

Ischemic Colitis: Clinical Presentation, Localization in Relation to Risk Factors, and Long-Term Results

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Ischemic colitis is commonly thought to occur most often in the left hemicolon close to the splenic flexure owing to insufficient blood supply near Griffith’s point. This study investigates the colorectal localization pattern, the risk factors, and the long-term outcome of histologically proven ischemic colitis.

Methods

Between 1996 and 2004, a total of 49 patients with a median age of 69 years (range 26–94 years) with colonoscopically assessed and histologically proven ischemic colitis were identified on behalf of the pathology database. Long-term results of 43 patients were evaluated retrospectively after a median interval of 79 months (range 6–163 months).

Results

In 27 patients (55%) more than one location was affected. We found 98 affected locations in 49 patients. The distribution of ischemic colitis in our group shows no significantly preferred location. In an exploratory analysis, the cecum, ascending colon, and right flexure were affected significantly more often if intake of a nonsteroidal antiinflammatory drug (NSAID) is documented. There was no association between the location of ischemic colitis and a history of smoking, peripheral artery occlusive disease, coronary heart disease, diabetes, or malignant tumor.

Conclusions

Ischemic colitis seems not to have a predisposing site of occurrence in the colorectum, especially Griffith’s point which was not afflicted significantly more often than other sites. Frequently, ischemic colitis afflicts more than one colonic location. In patients being treated with NSAIDs, ischemic colitis was observed significantly more often in the right hemicolon. Recurrence of ischemic colitis seems to be rare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Elder K, Lashner BA, Al Solaiman F (2009) Clinical approach to colonic ischemia. Cleve Clin J Med 76:401–409

    Article  PubMed  Google Scholar 

  2. Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92:419–424

    PubMed  CAS  Google Scholar 

  3. Vernava AM 3rd, Moore BA, Longo WE et al (1997) Lower gastrointestinal bleeding. Dis Colon Rectum 40:846–858

    Article  PubMed  Google Scholar 

  4. Green BT, Tendler DA (2005) Ischemic colitis: a clinical review. South Med J 98:217–222

    Article  PubMed  Google Scholar 

  5. Theodoropoulou A, Koutroubakis IE (2008) Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol 14:7302–7308

    Article  PubMed  Google Scholar 

  6. Scharff JR, Longo WE, Vartanian SM et al (2003) Ischemic colitis: spectrum of disease and outcome. Surgery 134:624–629; discussion 629–630

    Google Scholar 

  7. MacDonald PH (2002) Ischaemic colitis. Best Pract Res Clin Gastroenterol 16:51–61

    Article  PubMed  CAS  Google Scholar 

  8. Higgins PD, Davis KJ, Laine L (2004) Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther 19:729–738

    Article  PubMed  CAS  Google Scholar 

  9. Shaw RS, Green TH Jr (1953) Massive mesenteric infarction following inferior mesenteric-artery ligation in resection of the colon for carcinoma. N Engl J Med 248:890–891

    Article  PubMed  CAS  Google Scholar 

  10. Smith RF, Szilagyi DE (1960) Ischemia of the colon as a complication in the surgery of the abdominal aorta. Arch Surg 80:806–821

    PubMed  CAS  Google Scholar 

  11. Izbicki JR, Schneider CG, Kastl S (2003) Partial ischemia: occlusive and nonocclusive mesenteric ischemia, ischemic colitis, systemic lupus erythematosus. Chirurg 74:413–418

    Article  PubMed  CAS  Google Scholar 

  12. Zelenock GB, Strodel WE, Knol JA et al (1989) 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 106:771–779

    PubMed  CAS  Google Scholar 

  13. Brown DN, Rosenholtz MJ, Marshall JB (1994) Ischemic colitis related to cocaine abuse. Am J Gastroenterol 89:1558–1561

    PubMed  CAS  Google Scholar 

  14. Deana DG, Dean PJ (1995) Reversible ischemic colitis in young women: association with oral contraceptive use. Am J Surg Pathol 19:454–462

    Article  PubMed  CAS  Google Scholar 

  15. Patel YJ, Scherl ND, Elias S et al (1992) Ischemic colitis associated with psychotropic drugs. Dig Dis Sci 37:1148–1149

    Article  PubMed  CAS  Google Scholar 

  16. Johnson TD, Berenson MM (1991) Methamphetamine-induced ischemic colitis. J Clin Gastroenterol 13:687–689

    Article  PubMed  CAS  Google Scholar 

  17. Knudsen JF, Friedman B, Chen M et al (1998) Ischemic colitis and sumatriptan use. Arch Intern Med 158:1946–1948

    Article  PubMed  CAS  Google Scholar 

  18. Tada H, Saitoh S, Nakagawa Y et al (1996) Ischemic colitis during interferon-alpha treatment for chronic active hepatitis C. J Gastroenterol 31:582–584

    Article  PubMed  CAS  Google Scholar 

  19. Green BT, Branch MS (2003) Ischemic colitis in a young adult during sickle cell crisis: case report and review. Gastrointest Endosc 57:605–607

    Article  PubMed  Google Scholar 

  20. Kistin MG, Kaplan MM, Harrington JT (1978) Diffuse ischemic colitis associated with systemic lupus erythematosus: response to subtotal colectomy. Gastroenterology 75:1147–1151

    PubMed  CAS  Google Scholar 

  21. Yee NS, Guerry DT, Lichtenstein GR (2000) Ischemic colitis associated with factor V Leiden mutation. Ann Intern Med 132:595–596

    PubMed  CAS  Google Scholar 

  22. Richardson SC, Willis J, Wong RC (2003) Ischemic colitis, systemic lupus erythematosus, and the lupus anticoagulant: case report and review. Gastrointest Endosc 57:257–260

    Article  PubMed  Google Scholar 

  23. Byrd RL, Cunningham MW, Goldman LI (1987) Nonocclusive ischemic colitis secondary to hemorrhagic shock. Dis Colon Rectum 30:116–118

    Article  PubMed  CAS  Google Scholar 

  24. Longo WE, Ballantyne GH, Gusberg RJ (1992) Ischemic colitis: patterns and prognosis. Dis Colon Rectum 35:726–730

    Article  PubMed  CAS  Google Scholar 

  25. Binns JC, Isaacson P (1978) Age-related changes in the colonic blood supply: their relevance to ischaemic colitis. Gut 19:384–390

    Article  PubMed  CAS  Google Scholar 

  26. Meyers MA (1976) Griffiths’ point: critical anastomosis at the splenic flexure. Significance in ischemia of the colon. AJR Am J Roentgenol 126:77–94

    PubMed  CAS  Google Scholar 

  27. Steward JA, Rankin FW (1933) Blood supply of the large intestine: its surgical considerations. Arch Surg 26:843–891

    Google Scholar 

  28. Bower TC (1993) Ischemic colitis. Surg Clin North Am 73:1037–1053

    PubMed  CAS  Google Scholar 

  29. Yamazaki T, Shirai Y, Tada T et al (1997) Ischemic colitis arising in watershed areas of the colonic blood supply: a report of two cases. Surg Today 27:460–462

    Article  PubMed  CAS  Google Scholar 

  30. Price AB (1990) Ischaemic colitis. Curr Top Pathol 81:229–246

    PubMed  CAS  Google Scholar 

  31. Hunt RH, Buchanan JD (1979) Transient ischaemic colitis: colonoscopy and biopsy in diagnosis. J R Nav Med Serv 65:15–19

    PubMed  CAS  Google Scholar 

  32. Dignan CR, Greenson JK (1997) Can ischemic colitis be differentiated from C. difficile colitis in biopsy specimens? Am J Surg Pathol 21:706–710

    Article  PubMed  CAS  Google Scholar 

  33. Gandhi SK, Hanson MM, Vernava AM et al (1996) Ischemic colitis. Dis Colon Rectum 39:88–100

    Article  PubMed  CAS  Google Scholar 

  34. Hunter GC, Guernsey JM (1988) Mesenteric ischemia. Med Clin North Am 72:1091–1115

    PubMed  CAS  Google Scholar 

  35. Brandt LJ, Feuerstadt P, Blaszka MC (2010) Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol 105:2245–2252

    Article  PubMed  Google Scholar 

  36. Zou X, Cao J, Yao Y et al (2009) Endoscopic findings and clinicopathologic characteristics of ischemic colitis: a report of 85 cases. Dig Dis Sci 54:2009–2015

    Article  PubMed  Google Scholar 

  37. Acosta S, Ogren M, Sternby NH et al (2006) Fatal colonic ischemia: a population-based study. Scand J Gastroenterol 41:1312–1319

    Article  PubMed  Google Scholar 

  38. Carlson RM, Madoff RD (2011) Is “ischemic” colitis ischemic? Dis Colon Rectum 54:370–373

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital of Liestal (affiliated with the University of Basel), 4410, Liestal, Switzerland

    Philippe M. Glauser, Petra Wermuth, Samuel A. Käser & Christoph A. Maurer

  2. Institute of Pathology, Hospital of Liestal, Liestal, Switzerland

    Gieri Cathomas

  3. Clinical Trial Center, Faculty of Medicine, University of Leipzig, Leipzig, Germany

    Evelyn Kuhnt

Authors
  1. Philippe M. Glauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Petra Wermuth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gieri Cathomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evelyn Kuhnt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samuel A. Käser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph A. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph A. Maurer.

Additional information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glauser, P.M., Wermuth, P., Cathomas, G. et al. Ischemic Colitis: Clinical Presentation, Localization in Relation to Risk Factors, and Long-Term Results. World J Surg 35, 2549–2554 (2011). https://doi.org/10.1007/s00268-011-1205-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-011-1205-5

Keywords

Search

Navigation