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List of All Topics
Ischemic Colitis
Introduction
Ischemic colitis is a disorder in which part of your colon (large intestine) becomes inflamed and injured. The cause is usually a disruption or decline in blood flow to your colon, which can interfere with its normal functions.
Impaired blood flow to your colon can be either sudden and brief, or long-term. While ischemic colitis causes mild symptoms in many cases, the condition can become severe. If the deprivation of oxygen-rich blood is chronic, serious damage can result, with ulcers along the lining of your colon. The condition can even become life-threatening. Although this condition can affect any part of your colon, it involves pain on the left side of the abdomen in most people with the condition.
Also known as colonic ischemia, ischemic colitis occurs most often in people age 50 and older. In older adults, ischemic colitis is one of the most common medical conditions affecting the large bowel. Because ischemic colitis can be serious, see your doctor as soon as possible if you have serious bowel symptoms.
Signs and symptoms
Common signs and symptoms of ischemic colitis include:
- Abdominal pain, tenderness or cramping, usually localized to the lower left side of your abdomen; the onset can be sudden or gradual.
- Low-grade fever.
- Bright red or maroon-colored blood in your stool or, at times, passage of blood without stool.
- A feeling of urgency to move your bowels.
- Diarrhea.
- Nausea.
- Vomiting.
Ischemic colitis involves inadequate blood supply reaching your colon. In acute cases, the most frequent cause is blood clots in the arteries leading to your colon. Chronic cases are usually associated with the buildup of fatty deposits (atherosclerosis) in the blood vessels leading to your colon.
In some people, ischemic colitis may be caused by or related to other medical conditions, including:
- Inflammation of the blood vessels (vasculitis).
- Protrusion of an organ or tissue into the surrounding tissue, interfering with the arterial as well as the venous blood supply to the intestine (hernia).
- Elevated sugar, or glucose, levels in the blood (diabetes mellitus).
- Easy blood clotting (hypercoagulable state).
- Radiation treatment to the abdomen.
Certain medicines — for example, nonsteroidal anti-inflammatory drugs, estrogen replacement medications, blood pressure pills, digoxin and pseudoephedrine — also rarely can cause ischemic colitis as a side effect. A complication of the drug heparin is a decline in blood platelets (thrombocytopenia) with an unusual complication of thrombosis (clots) in the arteries and veins.
The prescription drug alosetron (Lotronex), used by women with severe irritable bowel syndrome (IBS), carries a Food and Drug Administration warning about its potential link to serious conditions including ischemic colitis.
Other causes
Abdominal surgery, particularly when it involves repair of a bulging arterial wall (aneurysm) in the region, is occasionally followed by ischemic colitis. In some cases, ischemic colitis may be triggered by infections involving bacteria (such as Escherichia coli), viruses (cytomegalovirus) or parasites (Entamoeba histolytica).
Treatment
The choice of treatment depends on the severity of your condition.
When ischemic colitis is mild, your doctor may prescribe medications to keep your blood pressure at normal levels, which will help facilitate blood flow to your colon. You may also need to take antibiotics to prevent infections from developing. Your doctor will treat any underlying health problems, such as heart failure, and may prescribe an aspirin a day.
With such conservative measures, symptoms often diminish in 24 to 48 hours in mild cases, without the need for hospitalization.
However, if you're dehydrated, you may need hospitalization to provide fluids and nutrients through your veins (intravenously). You may also need restrictions on food intake for a few days to let your intestines rest.
Your doctor will continue to monitor you regularly with follow-up colonoscopies to determine whether the disease has healed or progressed, and whether complications have developed. In mild cases, healing may occur in two weeks or less. In more severe cases, recovery can take as long as six months, and relapses can occur.
If you develop ischemic colitis before the age of 50 or have a history of blood clots, you could have a disorder increasing the tendency of your blood to clot. Your doctor may treat this with a blood thinner such as warfarin, which could help prevent the likelihood of future ischemic colitis episodes.
Surgery
Surgery may be necessary in some people with ischemic colitis. You may need surgery if you have abdominal tenderness and fever that are severe and persistent, despite initial conservative medical care.
You may also need surgery if you've developed a localized constriction in your arteries. Your doctor may also recommend surgery if bleeding associated with ulcers occurs or if there's a hole (perforation) in your colon. The diseased portion of your colon can be removed during surgery (surgical resection).
For gangrene and the blood infection (sepsis) that accompanies ischemic colitis, treatment is typically with broad-spectrum antibiotics, blood replacement (if there is considerable anemia), and surgical removal of the diseased sections of the bowel.
Prevention
There are no proven preventive approaches for ischemic colitis.
However, if you have underlying conditions associated with a risk of ischemic colitis — including coronary heart disease and high blood pressure — make sure you're receiving ongoing treatment. Your doctor may recommend that you:
- Stop smoking.
- Take cholesterol-lowering medication.
- Treat high blood pressure.
- Exercise regularly.
Information obtained from National Institute of Health