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Colonic ischemia

Definition
Colon ischemia is an injury to the colon due to reduced blood flow characterized by bloody bowel movements, abdominal pain, and leukocytosis.
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Pathophysiology
Colon ischemia is caused by an acute compromise in intestinal (mainly splenic flexure and sigmoid colon) blood flow (due to superior mesenteric artery, inferior mesenteric artery, and collateral blood supply).
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Disease course
The transient hypoperfusion of a part of the colon (mainly splenic flexure and sigmoid colon) results in colon ischemia, which causes clinical manifestations of acute onset of crampy abdominal pain, and bloody bowel movements. Severe ischemic may lead to peritonitis and sepsis.
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Prognosis and risk of recurrence
The in-hospital mortality in patients with acute mesenteric ischemic undergoing intestinal resection due to necrosis is high at 56.7%.
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Key sources
The following summarized guidelines for the evaluation and management of colonic ischemia are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG 2015).
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Guidelines

1.Screening and diagnosis

Clinical presentation
Assess for colon ischemia in the presence of symptoms including sudden cramping, mild, abdominal pain; an urgent desire to defecate; and passage within 24 hours of bright red or maroon blood or bloody diarrhea.
B
Assess for non-isolated right colon ischemia in patients with hematochezia.
B
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2.Diagnostic investigations

Diagnostic imaging: obtain CT with intravenous and oral contrast as the initial imaging modality for patients with suspected colon ischemia.
B

More topics in this section

  • Colonoscopy

3.Medical management

General principles: recognize that most cases of colon ischemia resolve spontaneously and do not require specific therapy.
B

More topics in this section

  • Antibiotic therapy

4.Surgical interventions

Indications for surgery: perform surgical intervention:
in the presence of colon ischemia accompanied by hypotension, tachycardia, and abdominal pain without rectal bleeding
for isolated right sided colon ischemia and pan-colonic colonic ischemia
in the presence of large bowel gangrene
B