Ischemic Colitis
Ischemic colitis is injury of the large intestine that results from an interruption of its blood supply.
Ischemic colitis may result from sudden (acute) or, more commonly, long-term (chronic) blockage of blood flow through arteries that supply the large intestine. Blood clots can produce acute blockage; deposits of fatty material (atherosclerosis) can lead to chronic blockage. Damage of the inside lining and inner layers of the wall of the large intestine results; the degree of damage depends on the duration and severity of the blockage. The damage produces ulcers (sores) in the lining of the large intestine. Ischemic colitis affects primarily people who are 50 or older.
Symptoms and Diagnosis
Usually, the person experiences abdominal pain. The pain is felt more often on the left side, but it can occur anywhere in the abdomen. The person frequently passes loose stools that are often accompanied by dark red clots. Sometimes bright red blood is passed without stool. Low-grade fevers (usually below 100° F [37.7° C]) are common.
A doctor may suspect ischemic colitis on the basis of the symptoms, especially in a person older than 50. An abdomen that is tender when pressed gently is further evidence of ischemic colitis. A colonoscopy or barium enema is needed to distinguish ischemic colitis from other forms of inflammation, such as infection or inflammatory bowel disease.
Prognosis and Treatment
People with ischemic colitis are hospitalized. Initially, the person is given neither fluids nor food by mouth so that the intestine can rest. Instead, intravenous fluids, electrolytes, and nutrients are given. Antibiotics are often given to prevent infection that might follow the inflammation. Within a few days, antibiotics are usually stopped and eating is resumed. More than 50% of people with ischemic colitis improve and recover over a period of 1 to 2 weeks. However, when the interruption to the blood supply is more severe or more prolonged, the affected portion of the large intestine may have to be surgically removed.
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