ischemic colitis
Definition & pathophysiology
- Nonocclusive disease 2° to Δs in systemic circulation or anatomic/fxnal Δs in local mesenteric vasculature; often underlying etiology unknown, frequently seen in elderly
- “Watershed” areas (splenic flexure & rectosigmoid) most susceptible; 25% involve R side; confers worse prognosis (Clin Gastroenterol Hepatol 2015;13:1969)
Clinical manifestations, diagnosis, & treatment
- Usually p/w cramping LLQ pain w/ overtly bloody stool; fever and peritoneal signs should raise clinical suspicion for infarction
- Disease spectrum: reversible colopathy (35%), transient colitis (15%), chronic ulcerating colitis (20%), resulting stricture (10%), gangrene (15%), fulminant colitis (<5%)
- Dx: flex sig/colonoscopy or CT abd/pelvis to make diagnosis; r/o IBD, infectious colitis
- Treatment: bowel rest, IV fluids, broad-spectrum abx, serial abd exams; surgery for infarction, fulminant colitis, hemorrhage, failure of med Rx, recurrent sepsis, stricture
- Resolution w/in 48 h w/ conservative measures occurs in >50% of cases