Skip to main content
SpringerLink
Log in

The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review

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

Abstract

There are currently no guidelines on the long-term management of patients after an episode of acute ischaemic colitis. Our aim was to review the literature on the pattern of presentation and the pathophysiology of this condition and to understand the current status of the acute and long-term management of ischaemic colitis. Furthermore, we aim to provide recommendations for the clinicians in regard to the acute and long-term management of ischaemic colitis. A review of the English literature over the last 15 years was performed using Embase and Medline. Search terms were ischaemic OR ischemic, colitis OR colon. Two reviewers screened the papers against pre-determined eligibility criteria. A senior consultant surgeon performed a final overview. Three hundred sixty-eight papers were identified on the initial search; 318 were irrelevant and 17 were conference abstracts; both were excluded. Thirty-three full articles were assessed for suitability; nine were further excluded. Twenty-four articles were included in the final analysis and cross-referenced against those listed in the systematic reviews. There is a large clinical heterogeneity in inclusion criteria (histological, radiological, endoscopic, surgical specimen). Twelve out of 24 articles included patients only based on histological diagnosis. The definition of right and left (or nonright) ischaemic colitis was variable based on whether hepatic or splenic flexure was used as the cut-off point. Five retrospective case series highlighted that patients with isolated right-sided ischaemic colitis had a worse prognosis than those with left-sided colitis (higher mortality, need for surgery, length of hospital stay). The overall recurrence was 9%. There is a need for a higher-level evidence to guide clinicians on the long-term management of patients following an episode of acute colonic ischaemia. Further evidence is required to determine whether right colonic ischaemia should be managed differently from left.

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

Similar content being viewed by others

References

  1. Brandt LJ, Feuerstadt P, Longstreth GF et al (2015) ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol 110:18–44

    Article  Google Scholar 

  2. Trotter JM, Hunt L, Peter MB (2016) Ischaemic colitis. BMJ 355:0959–8138. https://doi.org/10.1136/bmj.i6600

    Article  Google Scholar 

  3. Ryoo SB, Oh HK, Ha HK et al (2014) The outcomes and prognostic factors of surgical treatment for ischemic colitis: What can we do for a better outcome? Hepatogastroenterology 61(130):336–342

    PubMed  Google Scholar 

  4. O’Neill S, Elder K, Harrison SJ et al (2012) Predictors of severity in ischaemic colitis. Int J Colorectal Dis 27(2):187–191

    Article  Google Scholar 

  5. Huguier M, Barrier A, Boelle PY et al (2006) Ischemic colitis. Am J Surg 192(5):679–684

    Article  Google Scholar 

  6. Leardi S, De Vita F, Felici S et al (2006) Acute ischaemic colitis: outcome in elderly patients. Chir Ital 58(3):309–313

    PubMed  Google Scholar 

  7. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  Google Scholar 

  8. Excellence NIFH (2018) Quality assessment for case series. http://www.nice.org.uk/guidance/cg3/resources/appendix-4-quality-of-case-series-form2. Accessed 3 Nov 2018

  9. Wells GA, Shea B, O’Connell D et al (2008) The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinicalepidemiology/oxford.asp. Accessed 14 Nov 18

  10. Sotiriadis J, Brandt L, Behin D et al (2007) Ischemic colitis has a worse prognosis when isolated to the right side of the colon. Am J Gastroenterol 102(10):2247–2252

    Article  Google Scholar 

  11. Ten Heggeler LB, van Dam LJ, Bijlsma A et al (2017) Colon ischemia: right-sided colon involvement has a different presentation, aetiology and worse outcome. A large retrospective cohort study in histology proven patients. Best Pract Res Clin Gastroenterol 31:111–117

    Article  Google Scholar 

  12. Yadav S, Dave M, Edakkanambeth J et al (2015) A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol 13(4):731–738

    Article  Google Scholar 

  13. Sherid M, Sifuentes H, Samo S et al (2014) Ischemic colitis: a forgotten entity. Results of a retrospective study in 118 patients. J Dig Dis 15(11):606–613

    Article  Google Scholar 

  14. Cosme A, Montoro M, Santolaria S et al (2013) Prognosis and follow-up of 135 patients with ischemic colitis over a five-year period. World J Gastroenterol 19(44):8042–8046

    Article  Google Scholar 

  15. Peixoto A, Silva M, Gaspar R et al (2017) Predictive factors of short-term mortality in ischaemic colitis and development of a new prognostic scoring model of in-hospital mortality. United Eur Gastroenterol J 5(3):432–439

    Article  Google Scholar 

  16. Mosele M, Cardin F, Inelmen EM et al (2010) Ischemic colitis in the elderly: predictors of the disease and prognostic factors to negative outcome. Scand J Gastroenterol 45(4):428–433

    Article  Google Scholar 

  17. Lee TC, Wang HP, Chiu HM et al (2010) Male gender and renal dysfunction are predictors of adverse outcome in nonpostoperative ischemic colitis patients. J Clin Gastroenterol 44:e96–e100

    Article  Google Scholar 

  18. Jin NC, Kim HS, Kim HD et al (2011) A comparison of clinical characteristics between medically-treated patients and surgically-treated patients with ischemic colitis. Clin Endosc 44(1):38–43

    Article  Google Scholar 

  19. Gilshtein H, Hallon K, Kluger Y (2018) Ischemic colitis caused increased early and delayed mortality. World J Emerg Surg 13:31

    Article  Google Scholar 

  20. 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(10):2245–2252

    Article  Google Scholar 

  21. Medina C, Vilaseca J, Videla S et al (2004) Outcome of patients with ischemic colitis: review of fifty-three cases. Dis Colon Rectum 47(2):180–184

    Article  Google Scholar 

  22. Chavalitdhamrong D, Jensen DM, Kovacs TO et al (2011) Ischemic colitis is a common cause of severe hematochezia and patient outcomes are worse than with other colonic diagnoses. Gastrointest Endosc 74(4):852–857

    Article  Google Scholar 

  23. Mosli M, Parfitt J, Gregor J (2013) Retrospective analysis of disease association and outcome in histologically confirmed ischemic colitis. J Dig Dis 14(5):238–243

    Article  Google Scholar 

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

    Article  Google Scholar 

  25. Glauser PM, Wermuth P, Cathomas G et al (2011) Ischemic colitis: clinical presentation, localization in relation to risk factors, and long-term results. World J Surg 35(11):2549–2554. https://doi.org/10.1007/s00268-011-1205-5

    Article  PubMed  Google Scholar 

  26. Longstreth GF, Hye RJ (2015) Right-side colon ischemia: clinical features, large visceral artery occlusion, and long-term follow-up. Perm J Fall 19(4):11–16

    Google Scholar 

  27. Montoro MA, Brandt LJ, Santolaria S (2011) 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 46:236–246

    Article  Google Scholar 

  28. Yang XS, Lu YM, Yu CF et al (2003) Clinical and endoscopic features of ischemic colitis. Chin J Dig Dis 4:64–68

    Article  Google Scholar 

  29. Moszkowicz D, Trésallet C, Mariani A et al (2014) Ischaemic colitis: indications, extent, and results of standardized emergency surgery. Dig Liver Dis 46(6):505–511

    Article  Google Scholar 

  30. Oxford Centre for Evidence based Medicine (2009). https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 14 Nov 18

  31. O’Neill S, Yalamarthi S (2012) Systematic review on the management of ischaemic colitis. Colorectal Dis 14(11):e751–e763

    Article  Google Scholar 

  32. Fernandez JC, Calvo LN, Vazquez EG et al (2010) Risk factors associated with the development of ischemic colitis. World J Gastroenterol 16(36):4564–4569

    Article  Google Scholar 

  33. Sun D, Wang C, Yang L et al (2016) The predictors of the severity of ischaemic colitis: a systematic review of 2823 patients from 22 studies. Colorectal Dis 18(10):949–958

    Article  CAS  Google Scholar 

  34. Diaz Nieto R, Varcada M, Ogunbiyi OA et al (2011) Systematic review on the treatment of ischemic colitis. Coloretal Dis 13(7):744–747

    Article  CAS  Google Scholar 

  35. Washington C, Carmichael JC (2012) Management of ischemic colitis. Clin Colon Rectal Surg 25(4):228–235

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the library of Royal College of Surgeons of England for their invaluable assistance in the literature review and the library of South Tyneside District Hospital for providing access to all the papers required. We also thank Dr. Nadia Kathrada for her contribution in editing the manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, South Tyneside NHS Foundation Trust, South Shields, UK

    George Demetriou, Ahmed Nassar & Sriram Subramonia

  2. Department of General Surgery, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    George Demetriou

Authors
  1. George Demetriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed Nassar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sriram Subramonia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GD was involved in the data collection, analysis and writing of the manuscript. AN contributed to the data collection and analysis. SS supervised the entire process.

Corresponding author

Correspondence to George Demetriou.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demetriou, G., Nassar, A. & Subramonia, S. The Pathophysiology, Presentation and Management of Ischaemic Colitis: A Systematic Review. World J Surg 44, 927–938 (2020). https://doi.org/10.1007/s00268-019-05248-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05248-9

Search

Navigation