Ischemic colitis is a transient reduction in blood flow to the colon. Symptoms are left lower quadrant pain and rectal bleeding. Diagnosis is by CT or colonoscopy. Treatment is supportive with IV fluids, bowel rest, and antibiotics.
Necrosis may occur but is usually limited to the mucosa and submucosa, only occasionally causing full-thickness necrosis necessitating surgery. Ischemic colitis occurs mainly in older adults (> 60) and is thought to be caused by small-vessel atherosclerosis. It can also be a complication of abdominal aortic aneurysm repair.
Symptoms and Signs of Ischemic Colitis
Symptoms of ischemic colitis are milder and of slower onset than those of acute mesenteric ischemia and consist of left lower quadrant pain followed by rectal bleeding. The pathophysiology and treatment of the 2 conditions are quite different.
Diagnosis of Ischemic Colitis
CT or colonoscopy
Diagnosis of ischemic colitis is made by CT or colonoscopy.
Angiography or magnetic resonance angiography is not indicated.
Treatment of Ischemic Colitis
IV fluids, bowel rest, and antibiotics
Rarely surgery
Treatment of ischemic colitis is supportive with IV fluids, bowel rest, and antibiotics (1).
The underlying cause of the low-flow state (eg, control of cardiac arrhythmia) is treated if relevant.
Surgery is rarely required, unless ischemic colitis is a complication of a vascular procedure or there is full-thickness necrosis. Approximately 5% of patients have a recurrence (2).
Occasionally, strictures develop at the site of the ischemia several weeks later, necessitating surgical resection.
Treatment references
1. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology. 2000;118(5):954-968. doi:10.1016/s0016-5085(00)70183-1
2. FitzGerald JF, Hernandez Iii LO. Ischemic colitis. Clin Colon Rectal Surg. 2015;28(2):93-98. doi:10.1055/s-0035-1549099
