Ischemic colitis

We can define ischemic colitis as an alteration of the colon, caused by a sudden interruption of blood supply to it, either totally or partially. It is the most common ischemic involvement of the digestive system and the most common colon disease in the elderly.

The colon is part of the large intestine, along with the sigmoid and rectum.

It is anatomically divided into three parts:

• ascending or right colon.
• transverse colon.
• descending or left colon.

The junction between the ascending colon and the transverse colon is called the hepatic flexure of the colon, and that of the transverse colon with the descending colon is called the splenic flexure.

It is in the splenic flexure and in the descending colon where ischemic colitis appears most frequently; although it can appear in any location in the colon, generally diffusely.

Causes of ischemic colitis

This pathology mainly affects individuals over 60 years of age, with a predominance of males.

The clinical picture varies according to the degree of involvement of the colon wall:

• In the case of ischemic colitis that affects only the mucosa and submucosa, the most frequent symptom is abdominal pain in the form of cramps and located on the left side of the abdomen. In addition, there is usually abdominal distention, an urgent need to defecate, bloody diarrhea and fever . These lesions usually improve in a short time, disappearing the symptoms.
• In stenosing ischemic colitis, acute abdominal pain may appear, caused by incomplete occlusion of the colon.
• If gangrenous colitis appears, the symptoms will be much more important, with more intense and continuous pain, and abundant blood loss. In addition, the passage of intestinal content to the abdominal cavity will produce peritoneal irritation, which will be manifested by the appearance of a rigid or plank abdomen, and intestinal paralysis. It is usually accompanied by a significant impairment of the general state, with a tendency to the appearance of shock.

How is it diagnosed?

Diagnosis is based on clinical data, radiology, and colonoscopy .

1. In the segmental forms, the plain abdominal radiograph may be normal or reveal colic dilation. The use of contrast can reveal the existence of ulcers, which are filled with it. In the colonoscopy we can observe a pale mucosa, due to the lack of blood supply to the affected area and the existence of an ulcer.
2. In the stenosing forms, we can verify the decrease in the diameter of the intestinal lumen, by radiography with barium contrast or by colonoscopy.
3. In necrotizing colitis, the use of contrast and colonoscopy is contraindicated, due to the risk of perforation. Therefore, the diagnosis is made by means of a simple abdominal X-ray or arteriography, in which we can appreciate the lack of blood supply to the affected areas.

Treatment of ischemic colitis

Most of the time, the condition is solved by medical treatment, without the need for surgical intervention.

This will consist of good hydration and feeding of the patient by vein, refraining from feeding him orally. In addition, it is necessary to control the amount of blood lost, to assess the possibility of transfusing the patient. The administration of antibiotics is useful to reduce the risk of infection caused by bacteria in the colon.

Surgical treatment is reserved for colic strictures that cause occlusive problems and for severe necrotic colitis, in which a total resection of the colon may be necessary.

How to avoid it?

Since the main cause of ischemic colitis is arteriosclerosis, we must avoid any factor that favors its production, such as hypercholesterolemia, smoking, or high blood pressure .

We must suspect the existence of ischemic colitis in patients older than 60 years and with a history of arteriosclerosis who present abdominal pain in the form of cramps, accompanied by stools mixed with blood.