Ischemic Colitis

Ischemic Colitis is most commonly caused by systemic hypoperfusion, atherosclerosis or surgical disruption of blood flow in the inferior mesenteric artery after an aortic operation. Rarely it can be caused by a spontaneous arterial occlusion. Ischemic colitis primarily occurs in middle-aged and elderly patients. Acute ischemic colitis is associated with nonspecific findings such as fever, abdominal tenderness, and rectal bleeding. Patients commonly present with crampy lower abdominal pain, nausea, vomiting, and bloody diarrhea. Chronic colonic colitis may cause segmental ischemic strictures to develop, resulting in obstructive signs and symptoms. Abdominal X-ray will demonstrate "thumbprinting" of the mucosa, or thickening of the bowel wall. Angiography is rarely informative since most cases are the result of systemic hypoperfusion, not acute occlusions. Sigmoidoscopy may show an edematous, friable mucosa in the early stages and frank ulcerations in the later stages. Usually ischemic colitis will resolve with conservative measures that optimize cardiovascular function. Vasodilators and revascularization are not indicated. Necrotic segments may need to be surgically resected if the patient continues to deteriorate or develops peritonitis.