Ischemic Colitis
(Gastroenterology 2000;118:951-53 & 954-68)
DEFINITION:
The most common form of intestinal ischemic injury
EPIDEMIOLOGY:
Most are older than 60; The incidence is underestimated because many suffer only mild or transient damage and don’t seek medical attention
ETIOLOGIES:
Usually a non-occlusive low-flow state or thrombosis of IMA; Often times there is a low cardiac output ± high doses of vasoconstrictors
Risk factors: post-op valve surgery, hemodialysis with hypotensive episodes
Often no recognizable cause
Can result from alterations in systemic circulation or anatomic or functional changes in the local mesenteric vasculature
Risk factors: older age, vasculitidies, sickle cell, cocaine use, infection, long distance runners; Rarely embolus, hypercoagulable states
DDX: perforated viscus, small bowel obstruction, cecal volvulus, incarcerated hernia, dissecting aortic aneurysm, pancreatitis/cholecystitis
PATHOPHYSIOLOGY:
Mesenteric circulation (or splanchnic circulation):
Inflow with three major arteries: celiac axis (stomach, duodenum, spleen, liver), superior mesenteric artery or SMA (duodenum, entire small bowel, right colon), inferior mesenteric artery or IMA (left colon and rectum); Rectum also supplied by iliac arteries (dual supply)Related posts:
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