Skip to main content

Advertisement

SpringerLink
Log in

Update on Colon Ischemia: Recent Insights and Advances

  • Large Intestine (B Cash, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Colon ischemia (CI) is the most common manifestation of ischemic injury to the gastrointestinal (GI) tract. This usually self-limited disease is being diagnosed more frequently, and the list of known causes is increasing. Local hypoperfusion and reperfusion injury are both thought to contribute to the disease process, which manifests with a wide spectrum of injury including reversible colopathy (subepithelial hemorrhage and edema), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. The distribution is usually segmental with left-sided disease (e.g., inferior mesenteric artery distribution) being more frequently observed than right-sided involvement (e.g., superior mesenteric artery distribution). Any portion of the colon can be affected, but the anatomic distribution of CI recently has been shown to be associated with outcome. Patients with isolated-right colon ischemia (IRCI) have a different presentation and worse outcomes than other distributions of disease. Although somewhat variable depending on disease location, CI presents with cramping abdominal pains over the segment of colon involved followed by a short course of bloody diarrhea. Diagnosis is usually made clinically and is supported with serologic, radiologic, and colonoscopic findings. Colonoscopy is the most accurate diagnostic study. Most patients respond to conservative supportive therapy although some with more severe disease require antimicrobials and/or surgical intervention.

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

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Boley SJ, Schwartz S, Lash J, Sternhill V. Reversible vascular occlusion of the colon. Surg Gynecol Obstet. 1963;116:53–60.

    PubMed  CAS  Google Scholar 

  2. Brandt LJ, Feuerstadt P, Blaszka MC. Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol. 2010;105:2245–52. quiz 53. This retrospective study of 313 patients with biopsy proven ischemic colitis and complete colonoscopic or radiologic evaluation of disease distribution provides a comparative analysis of the medical co-morbidities, presentations and outcomes of ischemic colitis based on which segments of the colon are affected.

    Article  PubMed  Google Scholar 

  3. Montoro MA, Brandt LJ, Santolaria S, et al. 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. 2011;46:236–46. This prospective, multi-center study from Spain assessed 364 patients with definitive (pathologically proven) or probable CI showing the clinical patterns, segmental nature, clinical presentation, colonoscopic findings, histologic features, and outcomes for patients with CI.

    Article  PubMed  Google Scholar 

  4. Cole JA, Cook SF, Sands BE, Ajene AN, Miller DP, Walker AM. Occurrence of colon ischemia in relation to irritable bowel syndrome. Am J Gastroenterol. 2004;99:486–91.

    Article  PubMed  Google Scholar 

  5. Longstreth GF, Yao JF. Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia. Clin Gastroenterol Hepatol. 2009;7:1075–80. e1-2 quiz 23. This retrospective study of 401 patients with colon ischemia offers a comprehensive primary analysis of the epidemiology, high-risk features and outcomes of a cohort of patients with ischemic colitis.

    Article  PubMed  Google Scholar 

  6. Yadav S, Dave M, Varayil JE, et al. A population-based Study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clin Gastroenterol Hepatol. 2014. This retrospective nested case-control study compared 445 patients with definite (pathologically proven) or probable CI with 890-matched control patients in Olmstead County, Minnesota between 1976 and 2009. The study assessed the demographics, incidence, medical co-morbidities, pharmacologic exposures, and outcomes for these patients.

  7. Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ, American College of G. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015;110:18–44. quiz 5 This guideline provides the most comprehensive summary of the literature with critical evaluation for the epidemiology, risk factors, clinical presentation, diagnosis, severity, and management of CI.

    Article  PubMed  Google Scholar 

  8. Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management: chapter 118: intestinal ischemia. 10th ed. Philadelphia: Saunders/Elsevier; 2016.

    Google Scholar 

  9. Hreinsson JP, Gumundsson S, Kalaitzakis E, Bjornsson ES. Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting. Eur J Gastroenterol Hepatol. 2013;25:37–43.

    Article  PubMed  Google Scholar 

  10. Arroja B, Cremers I, Ramos R, et al. Acute lower gastrointestinal bleeding management in Portugal: a multicentric prospective 1-year survey. Eur J Gastroenterol Hepatol. 2011;23:317–22.

    Article  PubMed  CAS  Google Scholar 

  11. Feuerstadt P, Brandt LJ. Colon ischemia: recent insights and advances. Curr Gastroenterol Rep. 2010;12:383–90.

    Article  PubMed  Google Scholar 

  12. Schuler JG, Hudlin MM. Cecal necrosis: infrequent variant of ischemic colitis. Report of five cases. Dis Colon Rectum. 2000;43:708–12.

    Article  PubMed  CAS  Google Scholar 

  13. Kornblith PL, Boley SJ, Whitehouse BS. Anatomy of the splanchnic circulation. Surg Clin North Am. 1992;72:1–30.

    PubMed  CAS  Google Scholar 

  14. Boley SJ, Brandt LJ, Veith FJ. Ischemic disorders of the intestines. Curr Probl Surg. 1978;15:1–85.

    Article  PubMed  CAS  Google Scholar 

  15. Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am. 1992;72:203–29.

    PubMed  CAS  Google Scholar 

  16. Bharucha AE, Tremaine WJ, Johnson CD, Batts KP. Ischemic proctosigmoiditis. Am J Gastroenterol. 1996;91:2305–9.

    PubMed  CAS  Google Scholar 

  17. Feuerstadt P, Aroniadis O, Brandt LJ. Features and outcomes of patients with acute mesenteric ischemia accompanying or after ischemia isolated to the right side of the colon. Clin Gastroenterol Hepatol. 2015.

  18. Hass D, Kozuch P, Brandt L. Pharmacologically mediated colon ischemia. Am J Gastroenterol. 2007;102:1765–80. This article provides a comprehensive review of pharmacologically-mediated ischemic colitis including classes of medications commonly associated with ischemic colitis and their hypothesized mechanism of action .

    Article  PubMed  Google Scholar 

  19. Theodoropoulou A, Koutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol. 2008;14:7302–8.

    Article  PubMed  Google Scholar 

  20. Mosli M, Parfitt J, Gregor J. Retrospective analysis of disease association and outcome in histologically confirmed ischemic colitis. J Dig Dis. 2013;14:238–43.

    Article  PubMed  Google Scholar 

  21. Mosele M, Cardin F, Inelmen EM, et al. Ischemic colitis in the elderly: predictors of the disease and prognostic factors to negative outcome. Scand J Gastroenterol. 2010;45:428–33.

    Article  PubMed  Google Scholar 

  22. Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29:226–35.

    Article  PubMed  CAS  Google Scholar 

  23. Anon R, Bosca MM, Sanchiz V, et al. Factors predicting poor prognosis in ischemic colitis. World J Gastroenterol. 2006;12:4875–8.

    PubMed  PubMed Central  Google Scholar 

  24. Huguier M, Barrier A, Boelle PY, Houry S, Lacaine F. Ischemic colitis. Am J Surg. 2006;192:679–84.

    Article  PubMed  Google Scholar 

  25. Balthazar E, Yen B, Gordon R. Ischemic colitis: CT evaluation of 54 cases. Radiology. 1999;211:381–8.

    Article  PubMed  CAS  Google Scholar 

  26. Wolff JH, Rubin A, Potter JD, et al. Clinical significance of colonoscopic findings associated with colonic thickening on computed tomography: is colonoscopy warranted when thickening is detected? J Clin Gastroenterol. 2008;42:472–5.

    Article  PubMed  Google Scholar 

  27. Cruz C, Abujudeh HH, Nazarian RM, Thrall JH. Ischemic colitis: spectrum of CT findings, sites of involvement and severity. Emerg Radiol. 2015.

  28. Iacobellis F, Berritto D, Fleischmann D, et al. CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis. BioMed Research International. 2014;2014:895248.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Romano S, Romano L, Grassi R. Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol. 2007;61:433–41.

    Article  PubMed  Google Scholar 

  30. Church JM. Ischemic colitis complicating flexible endoscopy in a patient with connective tissue disease. Gastrointest Endosc. 1995;41:181–2.

    Article  PubMed  CAS  Google Scholar 

  31. Zou X, Cao J, Yao Y, Liu W, Chen L. Endoscopic findings and clinicopathologic characteristics of ischemic colitis: a report of 85 cases. Dig Dis Sci. 2009;54:2009–15.

    Article  PubMed  Google Scholar 

  32. Zuckerman GR, Prakash C, Merriman RB, Sawhney MS, DeSchryver-Kecskemeti K, Clouse RE. The colon single-stripe sign and its relationship to ischemic colitis. Am J Gastroenterol. 2003;98:2018–22.

    Article  PubMed  Google Scholar 

  33. Brandt L, Boley S, Goldberg L, Mitsudo S, Berman A. Colitis in the elderly. A reappraisal. Am J Gastroenterol. 1981;76:239–45.

    PubMed  CAS  Google Scholar 

  34. Diaz Nieto R, Varcada M, Ogunbiyi OA, Winslet MC. Systematic review on the treatment of ischaemic colitis. Colorectal Dis. 2011;13:744–7.

    Article  PubMed  CAS  Google Scholar 

  35. O'Neill S, Yalamarthi S. Systematic review of the management of ischaemic colitis. Colorectal Dis. 2012;14:e751–63.

    Article  PubMed  Google Scholar 

  36. Hourmand-Ollivier I, Bouin M, Saloux E, et al. Cardiac sources of embolism should be routinely screened in ischemic colitis. Am J Gastroenterol. 2003;98:1573–7.

    Article  PubMed  Google Scholar 

  37. Yoshiya K, Lapchak PH, Thai TH, et al. Depletion of gut commensal bacteria attenuates intestinal ischemia/reperfusion injury. Am J Physiol Gastrointest Liver Physiol. 2011;301:G1020–30.

    Article  PubMed  CAS  Google Scholar 

  38. Luo CC, Shih HH, Chiu CH, Lin JN. Translocation of coagulase-negative bacterial staphylococci in rats following intestinal ischemia-reperfusion injury. Biol Neonate. 2004;85:151–4.

    Article  PubMed  Google Scholar 

  39. Jamieson W, Pliagus G, Marchuk S, et al. Effect of antibiotic and fluid resuscitation upon survival time in experimental intestinal ischemia. Surg Gynecol Obstet. 1988;167:103–8.

    PubMed  CAS  Google Scholar 

  40. Castleberry AW, Turley RS, Hanna JM, et al. A 10-year longitudinal analysis of surgical management for acute ischemic colitis. J Gastrointest Surg. 2013;17:784–92.

    Article  PubMed  Google Scholar 

  41. Ibrahim CB, Aroniadis OC, Brandt LJ. On the role of ischemia in the pathogenesis of IBD: a review. Inflamm Bowel Dis. 2010;16:696–702.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Center of Connecticut, Clinical Instructor of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Paul Feuerstadt

  2. Division of Gastroenterology, Montefiore Medical Center, Bronx, NY, USA

    Lawrence J. Brandt

Authors
  1. Paul Feuerstadt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence J. Brandt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Feuerstadt.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Large Intestine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feuerstadt, P., Brandt, L.J. Update on Colon Ischemia: Recent Insights and Advances. Curr Gastroenterol Rep 17, 45 (2015). https://doi.org/10.1007/s11894-015-0469-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-015-0469-6

Keywords

Search

Navigation