Materiały źródłowe

• #1 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2778113/

  Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form. […] The etiology of ischemic colitis is multifactorial and the clinical presentation variable. […] An acute, self-limited compromise in intestinal blood flow which is inadequate for meeting the metabolic demands of a region of the colon is the underlying pathophysiology. […] Colonic blood flow may be compromised by changes in the systemic circulation or by anatomic or functional changes in the local mesenteric vasculature. […] A state of increased coagulability, although not extensively investigated, has been raised as a significant factor in the pathogenesis of IC. […] The colon is predisposed to ischemia by its relatively low blood flow and its less developed microvasculature plexus compared with the small bowel.

• #2 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v14/i48/7302.htm

  Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form. […] The etiology of ischemic colitis is multifactorial and the clinical presentation variable. […] An acute, self-limited compromise in intestinal blood flow which is inadequate for meeting the metabolic demands of a region of the colon is the underlying pathophysiology. […] Colonic blood flow may be compromised by changes in the systemic circulation or by anatomic or functional changes in the local mesenteric vasculature. […] A state of increased coagulability, although not extensively investigated, has been raised as a significant factor in the pathogenesis of IC. […] Some cases of IC have been reported to be associated with genetic defects such as deficiencies of protein C, protein S, and antithrombin III, factor V Leiden (FVL) mutation, and prothrombin 20210G/A mutation, as well as acquired factors such as antiphospholipid antibodies.

• #3 Factors influencing hospital stay duration for patients with mild ischemic colitis: a retrospective study | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00665-4

  Ischemic colitis is the most prevalent ischemic injury of the gastrointestinal tract. […] Ischemic colitis (IC) is defined as the inflammation of the colon secondary to vascular insufficiency and ischemia, with abdominal pain, hematochezia, and diarrhea being the most common manifestations. […] The severity of ischemic necrosis varies from superficial injury to the mucosa and submucosa to full-thickness transmural necrosis of the colonic wall. […] More than three-fourths of IC cases are the milder, nongangrenous form; however, IC can progress to necrosis with a risk of mortality up to 50%. […] To date, multiple studies have reported numerous risk factors for IC, including cerebrovascular disease, hypertension, diabetes mellitus, previous history of abdominal surgery, irritable bowel syndrome, and constipation.

• #4 Ischemic Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4442720/

  As the name implies, ischemic colitis is thought to be an injury to the colon as a result of reduced blood flow. The insult can range from inflammation and superficial injury to full thickness necrosis. While this simplified explanation accounts for a portion of the cases, ischemic injury to the colon has been attributed to multiple other causes, and the pathophysiology is undoubtedly more complex. […] The pathophysiology of ischemic colitis is more often an acute, self-limited decrease in blood supply rather than a specific vascular lesion or embolic event. Angiography, when abnormal, shows narrowing of the small vessels and tortuosity of the long colonic arteries. […] The marginal artery runs along the splenic flexure, but is absent or underdeveloped in 5% of the population. Injury to the colon is believed to typically occur in the watershed areas of the splenic flexure (Grifith point) and sigmoid colon (Sudeck point).

• #5 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  Ischemic colitis is one of many types of colitis, which means inflammation in your colon. But unlike other types, ischemic colitis begins in your circulatory system. Reduced blood flow to your colon deprives the tissues of oxygen, causing an inflammatory response. If blood flow isnt restored, it could cause tissue death. […] Ischemic colitis is inflammation in your colon thats caused by ischemia, which means reduced blood flow. Blood supplies oxygen to the tissues in your body. If something interrupts or diminishes the blood supply to certain tissues, they suffer damage from the lack of oxygen. Inflammation is your bodys response to this injury. It causes discomfort, swelling and bleeding, but it means your tissues are trying to repair themselves. Ischemic colitis mainly affects the inner lining of your colon (mucosa), usually in one section of it. But ischemia thats more severe or lasts longer may do deeper damage to your colon.

• #6 Ischemic Colitis -The Gastrointestinal Atlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/ischemic_colitis.html

  The most common mechanism is an acute, self-limited compromise in intestinal blood flow. […] There are numerous conditions that predispose patients to ischemic colitis. The most common mechanism is hypotension from sepsis or impaired left ventricular function and hypovolemia from dehydration or hemorrhage producing a compromise in systemic perfusion and triggering a reflex mesenteric vasoconstriction. […] Ischemic colitis occurs as the result of a compromise in intestinal blood flow that can produce a spectrum of injury from transient self-limited ischemia to fulminant ischemia or transmural infarction. […] Ischemic colitis encompasses a number of clinical entities, all with an end result of insufficient blood supply to a segment or the entire colon. This disease results in ischemic necrosis of varying severities that can range from superficial mucosal involvement to full-thickness transmural necrosis.

• #6 Ischemic Colitis -The Gastrointestinal Atlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/ischemic_colitis.html

  Severe case of Ischemic Colitis […] This patient was successfully treated by surgery. A small amount of ascites was observed (bacterial culture: negative). The right colon is affected with large area of necrosis. […] Discrepancy between subjective symptoms and objective findings is a hallmark of ischemic colitis. Thus, diagnosis requires a high index of suspicion in the appropriate clinical setting. […] The diverse causes, variable clinical presentations, and severity makes the diagnosis and management of ischemic colitis a challenge. […] Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death.

• #7 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2778113/

  The colon is protected from ischemia by a collateral blood supply via a system of arcades connecting the two major arteries. […] The anatomy is highly variable, however, and certain areas are more vulnerable in some people. […] The splenic flexure and sigmoid colon are regions where two circulations meet each other (so-called watershed areas), have more limited collateral networks and therefore ischemic damage is more common in these areas. […] Ischemic tissue damage to the colon is thought to be a result of both local hypoperfusion during the ischemic period and reperfusion injury when blood flow returns. […] When the ischemic period is brief, reperfusion may be significant and accounts for most of the histologic and endoscopic damage present in IC. […] Histologic changes in IC include edema, distorted crypts, mucosal and submucosal hemorrhage, inflammatory infiltration in the lamina propria, granulation tissue, intravascular platelet thrombi and necrosis.

• #8 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  Ischemic colitis (also spelled ischaemic colitis) is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply (ischemia). […] Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. […] Ischemic colitis is often classified according to the underlying cause. Non-occlusive ischemia develops because of low blood pressure or constriction of the vessels feeding the colon; occlusive ischemia indicates that a blood clot or other blockage has cut off blood flow to the colon. […] The colon receives blood from both the superior and inferior mesenteric arteries. The blood supply from these two major arteries overlaps, with abundant collateral circulation via the marginal artery of the colon. However, there are weak points, or „watershed” areas, at the borders of the territory supplied by each of these arteries, such as the splenic flexure and the rectosigmoid junction. These watershed areas are most vulnerable to ischemia when blood flow decreases, as they have the fewest vascular collaterals.

• #9 Ischemic Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4442720/

  As the name implies, ischemic colitis is thought to be an injury to the colon as a result of reduced blood flow. The insult can range from inflammation and superficial injury to full thickness necrosis. While this simplified explanation accounts for a portion of the cases, ischemic injury to the colon has been attributed to multiple other causes, and the pathophysiology is undoubtedly more complex. […] The pathophysiology of ischemic colitis is more often an acute, self-limited decrease in blood supply rather than a specific vascular lesion or embolic event. Angiography, when abnormal, shows narrowing of the small vessels and tortuosity of the long colonic arteries. […] The marginal artery runs along the splenic flexure, but is absent or underdeveloped in 5% of the population. Injury to the colon is believed to typically occur in the watershed areas of the splenic flexure (Grifith point) and sigmoid colon (Sudeck point).

• #10

  https://step2.medbullets.com/gastrointestinal/120180/ischemic-colitis

  ischemic colitis is the result of blood flow reduction to the colon and is particularly prominent at the watershed areas of the colon where collateral blood flow is limited […] the splenic flexure and rectosigmoid junction are particularly at risk for ischemia […] nonocclusive colonic ischemia accounts for the mass majority of cases (95%) […] typically transient hypoperfusion […] examples include shock or systemic hypotension […] occlusive colonic ischemia can be embolic (e.g., spontaneous or iatrogenic) or thrombotic secondary to atherosclerotic disease.

• #11

  https://step1.medbullets.com/gastrointestinal/109097/ischemic-colitis

  medical condition characterized by inadequate blood supply to the large intestine leading to inflammation and injury of the colon […] ischemic colitis is the result of blood flow reduction to the colon and is particularly prominent at the watershed areas of the colon where collateral blood flow is limited […] the splenic flexure and rectosigmoid junction are particularly at risk for ischemia […] nonocclusive colonic ischemia accounts for the mass majority of cases (95%) […] typically transient hypoperfusion […] examples include shock, systemic hypotension or atherosclerosis of SMA […] occlusive colonic ischemia can be embolic (e.g., spontaneous or iatrogenic) or thrombotic secondary to atherosclerotic disease.

• #12 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v14/i48/7302.htm

  The colon is predisposed to ischemia by its relatively low blood flow and its less developed microvasculature plexus compared with the small bowel. […] The colon is protected from ischemia by a collateral blood supply via a system of arcades connecting the two major arteries. […] The anatomy is highly variable, however, and certain areas are more vulnerable in some people. […] The non-gangrenous form accounts for 80%-85% of cases. […] The disease is transient, and reversible in about 50% of cases. […] Chronic forms, presenting either as chronic segmental colitis or strictures, occur in 20%-25% and 10%-15% of cases, respectively. […] Ischemic tissue damage to the colon is thought to be a result of both local hypoperfusion during the ischemic period and reperfusion injury when blood flow returns.

• #13 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  Reduced blood flow in the arteries that supply blood to your colon causes inflammation in the tissues as a secondary effect. […] The arteries that supply your colon your superior and inferior mesenteric arteries are extra sensitive to anything that causes your blood vessels to constrict (vasoconstriction). This includes physical triggers like colds, medical conditions that cause low blood pressure and certain drugs (vasoconstrictors). These arteries respond to low blood pressure by constricting vigorously. Scientists believe this may be a survival mechanism designed to direct reduced blood flow to your more vital organs, like your brain and heart. As a result, your colon may be deprived of blood flow while this stress response is activated. […] Providers sometimes designate the causes of ischemic bowel disease as occlusive vs. nonocclusive. An occlusive cause is a blockage affecting one of your arteries. A nonocclusive cause is reduced blood flow without a blockage, such as from low blood pressure or narrowing of the arteries. A third cause is injury during surgery. While rare, this injury is a known risk of abdominal aortic aneurysm (AAA) repair. When this happens, it tends to be more severe than the other, more transient causes of ischemic colitis, and it can be life-threatening. It occurs in 2% to 3% of AAA surgeries, and the mortality rate among these is 50%.

• #14 Ischemic colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischaemic-colitis?ref=binfind.com/web

  Ischemic colitis refers to inflammation of the colon secondary to vascular insufficiency and ischemia. The severity and consequences of the disease are highly variable. […] Diminished or absent blood flow leads to bowel wall ischemia and secondary inflammation. Bacterial contamination may produce superimposed pseudomembranous inflammation. If necrosis develops then ulcerations or perforation can occur. Following the acute event, fibrosis may lead to stricture of the bowel lumen. Different pathological outcomes include gangrenous (15-20%) and non-gangrenous (80-85%): reversible and non-reversible (chronic colitis, stricture formation). […] The causes can be categorized as follows: arterial occlusion (arteriosclerosis, vasculitides, arterial emboli), venous thrombosis (hypercoagulative states including malignancy and oral contraceptive pill use, primary mesenteric venous thrombosis), low flow states (hypotension, congestive heart failure, cardiac arrhythmias), and others (sickle cell disease, radiation therapy).

• #15 Mayo Clinic Q and A: Understanding ischemic colitis – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-understanding-ischemic-colitis/

  The cause of ischemic colitis, a condition in which blood flow to part of the large intestine (colon) is reduced, often is not clear. The condition occurs when there is a blocked or narrowed blood vessel (occlusive), or when there is a temporary decrease in blood flow to the colon (nonocclusive). Most cases of ischemic colitis are due to a nonocclusive mechanism. When this occurs, the colon temporarily receives less blood flow than usual, which then leads to areas of colon inflammation and ulceration. […] The colon receives less blood flow than any other portion of the gastrointestinal tract, even under normal conditions. So if the colon is suddenly subjected to reduced blood flow for whatever the reason, the tissue may be damaged. The severity of this damage depends on the amount of time that the blood flow was interrupted and the extent of the decrease.

• #16 Mayo Clinic Q and A: Understanding ischemic colitis – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-understanding-ischemic-colitis/

  A number of situations can result in reduced blood flow to the colon. One cause is narrowing of arteries serving the colon, which often is associated with the buildup of fatty deposits (atherosclerosis). More commonly, decreased blood pressure due to dehydration, heart disease, severe illness, various medications, cocaine use or hemodialysis can decrease blood flow to the colon and cause an episode of ischemic colitis. […] Abdominal surgeries that require clamping off arteries that supply the colon with blood, such as during repair of an aortic aneurysm, also may result in ischemic colitis. Blood clots in the vessels supplying the colon may be due to an underlying clotting disorder or could have traveled from another part of the body, such as the heart.

• #17 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  If blood flow to the colon drops by more than about 50%, ischemia will develop. The arteries feeding the colon are very sensitive to vasoconstrictors; presumably this is an evolutionary adaptation to shunt blood away from the bowel and to the heart and brain in times of stress. […] A range of pathologic findings are seen in ischemic colitis, corresponding to the spectrum of clinical severity. In its mildest form, mucosal and submucosal hemorrhage and edema are seen, possibly with mild necrosis or ulceration. […] Following restoration of normal blood flow, reperfusion injury may also contribute to the damage to the colon.

• #18 Severe ischemic colitis following olanzapine use: a Case Report

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000900018

  Ischemic colitis is the most common subtype of intestinal ischemia usually resulting from vasospasm, vessel occlusion or mesenteric hypoperfusion. […] The underlying mechanism is believed to involve blockage of peripheral anticholinergic and antiserotonergic receptors leading to severe gastrointestinal hypomotility. […] The exact mechanism by which antipsychotics lead to ischemia is not yet fully understood. Inhibition of peripheral anticholinergic and antiserotonergic receptors has been proposed as the leading mechanism. […] Antagonism of these receptors has shown to limit gastrointestinal smooth muscle contraction leading to a delay in intestinal transit and constipation. […] Slow transit and progressive fecal accumulation lead to increased intraluminal pressure, reduced intestinal blood flow and subsequent tissue ischemia.

• #19 A Case of Ischemic Colitis Related with Usual Dosage of Ibuprofen in a Young Man

  https://www.kosinmedj.org/journal/view.php?doi=10.7180/kmj.2014.29.2.147

  Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. […] Other possible causes include medications such as NSAIDs (non-steroidal anti-inflammatory drugs), oral contraceptives, diuretics and others. […] In recent years, many of NSAID use in young age can cause ischemic lesions, but it is not common. […] It suggests the importance of precise history taking, including medications usage such as NSAIDs and other risk factors.

• #20 A Case of Ischemic Colitis Following Colonoscopy

  https://www.e-ce.org/journal/view.php?number=3357

  Ischemic colitis can be caused either by vascular or colonic wall factor or by both. […] Shunting of blood away from the mucosa may contribute to ischemia of the colon, but the mechanism of ischemia is not known. […] Ischemic colitis precipitated by colonoscopy has rarely been reported. […] Potentially air insufflation or mechanical effect during colonoscopic examination can cause ischemic colitis as a colonic wall factor.

• #21 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v14/i48/7302.htm

  When the ischemic period is brief, reperfusion may be significant and accounts for most of the histologic and endoscopic damage present in IC. […] Reperfusion injury may be associated with the release of oxygen free radicals which cause lipid peroxidation within cell membranes, resulting in cell lysis and tissue damage. […] When the ischemic period is of long duration, hypoperfusion deprives the involved bowel of oxygen and nutrients, leading to hypoxia and direct cell death. […] Histologic changes in IC include edema, distorted crypts, mucosal and submucosal hemorrhage, inflammatory infiltration in the lamina propria, granulation tissue, intravascular platelet thrombi and necrosis.

• #22 Ischemic colitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Ischemic_colitis_pathophysiology

  Ischemic colitis is the result of a sudden reduction in blood flow that is insufficient to meet the metabolic demands of the region of the colon. Ischemic changes will subsequently extend from the mucosa to the serosa. Mucosal injury will develop in 20 minutes to 1 hour and transmural infarction occurs within 8 to 16 hours. Reperfusion injury can occur with the release of reactive oxygen species, which cause lipid peroxidation within cell membranes, causing cell necrosis. […] The pathophysiology of ischemic colitis is as follows: […] If blood flow to the colon drops by more than about 50%, ischemia will develop. […] The arteries feeding the colon are very sensitive to vasoconstrictors and during periods of low blood pressure the arteries will collapse. […] Vasoconstricting drugs such as ergotamine, cocaine, or vasopressors can also cause colonic ischemia which results in non-occlusive ischemic colitis. […] Following restoration of normal blood flow, reperfusion injury may contribute to the damage to the colon.

• #23 Acute Mesenteric Ischemia: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/189146-overview

  Insufficient blood perfusion of the small bowel and colon may result from embolic or thrombotic arterial occlusion (AMAE or AMAT), thrombotic venous occlusion (ie, MVT), or nonocclusive processes such as vasospasm or low cardiac output (NOMI). […] Whether the occlusion is arterial or venous, hemorrhagic infarction leading to perforation is the common pathologic pathway. […] Injury severity is inversely proportional to the mesenteric blood flow and is influenced by the number of vessels involved, systemic mean blood pressure, duration of ischemia, and collateral circulation. […] Damage to the affected bowel portion may range from reversible ischemia to transmural infarction with necrosis and perforation. […] As the ischemia persists, the mucosal barrier becomes disrupted, and bacteria, toxins, and vasoactive substances are released into the systemic circulation. […] This can cause death from septic shock, cardiac failure, or multisystem organ failure before bowel necrosis actually occurs. […] As hypoxic damage worsens, the bowel wall becomes edematous and cyanotic. […] Bowel necrosis can occur in 8-12 hours from the onset of symptoms.

• #24 Ischemic colitis – Libre Pathology

  https://librepathology.org/wiki/Ischemic_colitis

  Ischemic colitis is inflammation of the colon due to a compromised blood supply. […] Ischemia = compromised blood supply. […] Anything that leads to vascular occlusion: Atherosclerosis, Vasculitis, Embolization, e.g. thrombotic, foreign body. […] Classic presentation: Abdominal pain, Urgency to defecate (tenesmus), Bloody diarrhea. […] Diarrhea may be non-bloody. […] Features: Withering crypts – important. Colonic epithelium has decreased cytoplasm – NC ratio increased. Usually with decreased goblet cells. […] Crypt loss/drop-out. […] Lamina propria hyalinization. […] Submucosa hyalinization. […] +/-Cryptitis. […] +/-Pseudomembranes (microscopic): Loss of surface epithelium. PMNs in lamina propria. +/-Capillary fibrin thrombi. […] The findings are consistent with ischemia; however, they are not diagnostic. […] The inflammation is largely associated with necrosis/ischemic changes and favoured to be reactive. […] A vascular compromise is favoured as the underlying cause.

• #25 Case Report: Ischemic Colitis in Severe COVID-19 Pneumonia: An Unforeseen Gastrointestinal Complication in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 1 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/1/article-p63.xml

  Clinical manifestations and complications of SARS-CoV-2 are still emerging and variant. […] The presence of angiotensin converting enzyme-2 receptors in the intestinal enterocytes, the receptors primarily involved in the pathogenesis of COVID-19 pneumonia, maybe the key factor contributing to the pathogenesis of GI manifestations. […] Ischemic colitis, although the most common ischemic pathology of the GI tract, is relatively rare, occurring as a result of colonic hypoperfusion. […] The cause of ischemia in COVID-19 pneumonia is multifactorial, including hypercoagulable state, coagulopathy leading to thromboembolic complications, and use of vasopressors in severely ill patients with hemodynamic compromise. […] Ischemia of the colon can lead to reversible or irreversible damage, the former of which includes colopathy and colitis.

• #26 Case Report: Ischemic Colitis in Severe COVID-19 Pneumonia: An Unforeseen Gastrointestinal Complication in: The American Journal of Tropical Medicine and Hygiene Volume 104 Issue 1 (2021)

  https://www.ajtmh.org/view/journals/tpmd/104/1/article-p63.xml

  SARS-CoV-2 has been linked to the development of coagulopathy and thromboembolic complications in severe COVID-19 patients. […] Imaging findings in severe COVID-19 demonstrate bowel necrosis secondary to small vessel thrombosis, highlighting the fact that ischemia is often due to in situ thrombosis, rather than due to thromboembolic events. […] Severe COVID-19 can lead to nonocclusive colonic ischemia, as shock and hemodynamic compromise are common in COVID-19 pneumonia. […] In critically ill patients, it is ideal to use vasopressors with caution, keeping in mind the ischemic complications, and diagnosing and managing them early in its course for better patient outcomes.

• #27 Association between SARS-CoV-2 infection and acute ischemic colitis | JIR

  https://www.dovepress.com/association-between-sars-cov-2-infection-and-acute-ischemic-colitis-peer-reviewed-fulltext-article-JIR

  Ischemic colitis appears to be a rare but serious complication of COVID-19. […] SARS-CoV-2 infection may induce transient acute colon ischemia within 2 weeks, accompanied by severe clinical symptoms such as acute abdominal pain and hematochezia, which are self-limiting and do not lead to chronic symptoms. […] However, how SARS-CoV-2 causes these ischemic changes remains uncertain. […] Recent study has proposed that a hypercoagulable state induced by SARS-CoV-2 infection can lead to intestinal ischemia. […] We inferred that this may be because all of our patients were admitted to the hospital at the early stage of ischemic bowel disease, and their rapid recovery might benefit from necessary supportive treatment, such as fluid infusion and oral probiotics, which can prevent intestinal hypoperfusion and bacterial translocation. […] The phenomenon we describe deserves further research.

• #28 Ischemic Colitis: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/

  Constipation and constipation-inducing drugs are thought to predispose to IC as distension of the bowel decreases blood supply to the mucosa and increases the risk of ischemia. […] Illicit drugs, particularly amphetamines and cocaine, can cause vasoconstriction, direct endothelial injury, and coagulopathy resulting in low flow states or vascular occlusion. […] IC should be differentiated from mesenteric ischemia in which a disruption of the mesenteric circulation results in ischemia of the small bowel. […] While both can occur in the setting of poor perfusion, acute mesenteric ischemia results in ischemia of the small bowel and acute mesenteric ischemia usually occurs due to occlusion of the superior mesenteric artery. […] Whereas, ischemic colitis affects the colon in the distribution of the inferior mesenteric artery.

• #29

  https://journals.lww.com/ajg/fulltext/2013/10001/lactulose_induced_ischemic_colitis__1289.1289.aspx

  Ischemic colitis in this individual was suspected due to lactulose therapy. […] The mechanism of lactulose-induced ischemic colitis in our patient may be similar. Fermentation of lactulose by colonic bacteria causes gaseous distention. The subsequent increase in intraluminal pressure leads to decreased intestinal blood flow, and in the case of our patient, intestinal ischemia. […] Patients undergoing aggressive lactulose administration should be monitored closely, and lactulose should be used cautiously in patients with signs of intestinal distention.

• #30 Severe ischemic colitis following olanzapine use: a Case Report

  http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000900018

  A third plausible mechanism may involve a complex interaction between intestinal dopamine receptors inhibiting mesenteric vasodilation. […] Inflammation and thrombotic phenomena at the level of submucosal capillaries may worsen intestinal ischemia. […] Treatment of ischemic colitis usually involves conservative measures (intestinal decompression through nasogastric tube placement or enemas), bowel rest, intravenous fluids and broad-spectrum antibiotics to reduce bacterial translocation. […] In the absence of response to conservative treatment or when evidence of intestinal infarction or perforation exists, early surgical consultation with resection of the diseased bowel should be undertaken.

• #31 Predictive Factors for Severe Outcomes in Ischemic Colitis

  https://www.gutnliver.org/journal/view.html?pn=search&uid=744&vmd=Full

  In previous studies, the following poor prognostic factors have been found: old age, showing hemodynamic instability at an early stage of ischemic colitis, continued colon paralysis, involvement of right colon, medical history of hypertension and malignant tumors, and end-stage renal disease with hemodialysis. […] The study aimed to determine prognostic factors that influence severe ischemic colitis, showed that chronic kidney disease (odds ratio [OR], 5.289; 95% confidence interval [CI], 1.31 to 21.38; p=0.019) and high ECOG performance status score (OR, 1.690; 95% CI, 1.11 to 2.58; p=0.015) were significant risk factors. […] In particular, involvement of the right colon has been known to be related to poor prognosis of ischemic colitis in a number of study results owing to decreased blood flow in the superior mesenteric artery in the right colon creating more severe clinical manifestations by extensive ischemic injury in the colon.

• #32 Predictive Factors for Severe Outcomes in Ischemic Colitis

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl15167

  In previous studies, the following poor prognostic factors have been found: old age, showing hemodynamic instability at an early stage of ischemic colitis, continued colon paralysis, involvement of right colon, medical history of hypertension and malignant tumors, and end-stage renal disease with hemodialysis. However, these factors have differed across studies. […] The study subjects were 292 patients from four university hospitals and two secondary hospitals. Among them, the mild group had 259 patients and the severe group, 33 patients. Among patients in the severe group, five had surgical treatment and 28 died later. A comparison of the comorbidities between the two groups showed no significant difference in the ratio of high blood pressure, diabetes, cardiovascular and cerebrovascular diseases, arrhythmia, peripheral vascular disease, thyroid disease, chronic obstructive pulmonary disease, irritable bowel syndrome, and hyperlipidemia; however, the ratio of chronic kidney disease with hemodialysis was significantly higher in the severe group than in the mild group.

• #33 Ischemic Colitis | PPT

  https://www.slideshare.net/slideshow/ischemic-colitis/1281262

  Ischemic colitis is the most common form of intestinal ischemia. […] Two basic mechanisms may cause bowel ischemia: 1. Diminished bowel perfusion. 2. Occlusive disease of the vascular supply. […] Regardless of the mechanism, the disease follows the same course. Depending on the cause and severity, the morphologic pattern can be divided into 3 groups: Transient Ischemia, Partial thickness ischemia, and Full thickness infarction. […] Transient Ischemia/Partial Thickness is a result of hypoperfusion rather than occlusive disease. […] Full thickness is a result of thrombosis or embolism of SMA. […] Approximately 20% of patients with IC will require surgery because of peritonitis or clinical deterioration despite conservative management. Emergency resection of non-viable bowel is required and colostomy is usually required. […] Despite resection, the mortality rates exceed 50% in those with infarcted bowel.

• #34 Ischemic Colitis after Hemorrhagic Shock Due to Obstetrical Reasons

  https://www.heraldopenaccess.us/openaccess/ischemic-colitis-after-hemorrhagic-shock-due-to-obstetrical-reasons

  Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and arises from occlusion, vasospasm, and/or hypoperfusion of the mesenteric vessels. […] The most common mechanisms that can cause colonic ischemia are hypotension and hypovolemia in connection with sepsis, impaired left ventricular function, dehydration or hemorrhage producing a compromise in systemic perfusion and triggering a reflex mesenteric vasoconstriction. In our patient, hemorrhagic shock induced hypoperfusion which caused mesenteric ischemia. The state of increased coagulability due to pregnancy and the increase of peripheral vascular resistance due to preeclampsia probably contributed to the pathogenesis of ischemic colitis. […] Ischemic colitis is reversible in about half of the cases. Two thirds of patients with reversible disease will clinically improve within 24 to 48 hours, and resolving of all endoscopic and radiologic abnormalities may take 1 to 6 months. […] In conclusion, ischemic colitis is a rare but potentially lethal complication of hypotension due to hemorrhage. It is difficult to diagnose especially in young woman and difficult to treat. It should be kept in mind during the evaluation of postpartum hemorrhage and postoperative ileus cases.

• #35 Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

  https://www.mdpi.com/2075-4418/11/6/998

  The degree of ischemic vascular impairment, and the damage resulting from it, depend on several factors: the state of the systemic circulation, the anatomical or functional nature of the vascular alteration, the number and size of the affected vessels, the compensatory response of the vascular bed to the reduced perfusion, the nature and capacity of the collateral circulation, the duration of the ischemic insult, the metabolic demand of the intestinal segment involved and the presence/absence of reperfusion phenomena. […] The diminution of arterial blood flow often depends on a decrease in systemic perfusion (e.g., due to dehydration, hypotension or hypovolemia), but can also be due to a local dysregulation of blood supply, or to vessel occlusion. […] The diagnosis arises from a combination of clinical, laboratory suspicion and radiological, endoscopic and histopathological findings.

• #36 Ischemic Colitis | Abdominal Key

  https://abdominalkey.com/ischemic-colitis/

  Ischemic colitis affects patients of all ages including infants, but it preferentially affects elderly patients with a history of arteriosclerosis, diabetes, hypertension, renal insufficiency, and/or cardiovascular disease. […] The mesenteric arteries become atherosclerotic with either gradual arterial occlusion or acute blockage by a thrombus. […] The degree of ischemic damage depends on the adequacy of the collateral circulation, on vascular autoregulatory mechanisms, and on tissue resistance to hypoxia. […] The extent and pattern of disease also depends on the anatomy of the blood supply, duration of the hypoxic episode, and bacterial population within the bowel lumen. […] There are three phases in the colonic reaction to ischemia: (a) acute with hemorrhage and necrosis, (b) repair with the formation of granulation tissue and fibrosis, and (c) the formation of structures and other complications.

• #37 Predictive Factors for Severe Outcomes in Ischemic Colitis

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl15167

  The ECOG performance status score of the patients showed that the severe group had higher scores than the mild group. The which aimed to determine prognostic factors that influence severe ischemic colitis, showed that chronic kidney disease and high ECOG performance status score were significant risk factors. […] In conclusion, factors that can predict poor prognosis in ischemic colitis were comorbidity of chronic kidney disease and high ECOG performance status score. Therefore, it is necessary for patients with suspicious ischemic colitis to receive active treatment (e.g., surgery) at an early stage and to be observed carefully if they are treated with chronic kidney disease and if their performance status is poor overall.

• #38 Ischemic colitis induced by a platelet-raising capsule: A case report

  https://www.wjgnet.com/2307-8960/full/v12/i3/607.htm

  Ischemic colitis (IC) is also known as colon ischemia and is caused by colon vascular occlusion or nonocclusion, which results in a reduced blood supply to the colon and is not significant enough to maintain the metabolic function of cells, leading to intestinal wall ischemia. […] The pathogenesis of this disease has not been extensively studied, but increased clotting ability has been recognized as an important factor in the pathogenesis of IC. […] The lesions can involve any segment of the colon, among which the left half of the colon, such as the sigmoid colon, descending colon and spleen region, is the most common site of lesions. […] The disease is relatively mild and can be cured after conservative medical treatment, so the prognosis is favorable. […] Once ischemia improves, the patients condition can recover in a relatively short time, and this condition can be distinguished from other types of enteritis.

• #39 Ischemic Colitis Associated with Low-volume Oral Sulfate Solution for Bowel Preparation

  https://www.kjg.or.kr/journal/view.html?pn=related&uid=5569&vmd=Full&page=22&mid=2418&

  Ischemic colitis is caused by impaired blood perfusion to the intestine. It frequently affects the elderly with various clinical courses, from self-limited ischemia to life-threatening infarction and necrosis. Nonspecific symptoms such as abdominal pain, diarrhea, and hematochezia are frequently present, whereas mesenteric artery embolism or thrombosis, trauma, congestive heart failure, excessive physical activity, shock, and mechanical obstruction are well-known risk factors for this condition. […] Ischemic colitis resulting from bowel preparation for colonoscopy is extremely rare, with only a few cases due to administering polyethylene glycol (PEG) and bisacodyl having been reported worldwide. […] The diagnosis of ischemic colitis was made via colonoscopy, histologic examination, and a CT scan.

• #40 Stercoral colitis complicated with ischemic colitis: a double-edge sword | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-017-0686-6

  Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. […] The mechanism by which stercoral colitis leads to ischemia and colonic wall perforation is a result of increased intraluminal pressure from fecal impaction leading to ischemia of the bowel. […] The mechanism by which fecal impaction and chronic constipation can lead to stercoral inflammation, ulceration, and subsequently perforation is proposed to be distention of the colonic lumen and increased pressure from dry desiccated fecal material (also called fecaloma) which, if left untreated may result in perforation and peritonitis. […] The usual presentation of stercoral colitis complicated with ischemic colitis is the colicky abdominal pain, which may be diffuse or localized in a patient with a history of chronic constipation.

• #41 Stercoral colitis complicated with ischemic colitis: a double-edge sword | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-017-0686-6

  The CT scan findings of stercoral colitis include dilated sigmoid colon and/or rectum with subsequent thickening of the wall. This likely symbolizes edema caused by focal ischemia, necrosis and ulceration. […] Once the diagnosis made, the patient should be managed appropriately and promptly to avoid morbidity and mortality from bowel perforation and peritonitis. […] Hence, early diagnosis and treatment with bowel cleansing and fecal disimpaction are essential to avoid the fatal consequence of such condition. […] In summary, stercoral colitis complicated with ischemic colitis can lead to focal ulceration, perforation, peritonitis, septic shock and eventually death if left undiagnosed or if not treated.

• #42 Factors influencing hospital stay duration for patients with mild ischemic colitis: a retrospective study | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00665-4

  Our results show that right colonic involvement occurred more frequently in the patients who were hospitalized for 12 days than in those who were hospitalized for 8 days, although the difference was not significant. […] The ACG clinical guidelines recommend that patients with mild diseases, such as transient IC, usually have a good prognosis and, therefore, do not require special treatment. […] The major therapeutic measures currently used include intestinal rest, intravenous fluids, improvement of underlying conditions, and withdrawal of precipitated drugs. […] Our results indicate that antibiotic treatment may not significantly affect the hospital stay duration for patients with mild IC, which may be due to the inflammation caused by the use of antibiotics through the translocation of inherent colonic microflora.

• #43 Factors influencing hospital stay duration for patients with mild ischemic colitis: a retrospective study | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00665-4

  However, we found that probiotic use helped shorten the hospital stay for patients with mild IC, since the disease process can cause the destruction of the intestinal mucosal barrier, which may encourage bacteria to migrate into the circulatory system, whereas probiotic treatment can inhibit the infiltration and growth of pathogenic bacteria and maintain gut homeostasis.

• #44 Rare Clinical Association between Clostridioides difficile Infection and Ischemic Colitis: Case Report and Literature Review

  https://www.mdpi.com/1648-9144/57/7/705

  We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. […] Ischemic colitis (IC) results from diminished blood flow to the bowel wall and is the most frequently encountered type of intestinal ischemia. The ischemic injury can result in variable degree of colonic wall damage, ranging from superficial injury to full-thickness necrosis and perforation. […] Most frequently, ischemic colitis is caused by non-occlusive ischemic injury to the bowel wall through sudden decrease in blood supply in the small vessels of the colon, usually secondary to a low circulating volume state.

• #45

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #46

  https://scholars.duke.edu/publication/1047593

  Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. […] Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. […] Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients.

• #47 Ischemic Colitis | Abdominal Key

  https://abdominalkey.com/ischemic-colitis/

  The severity of the lesions varies from microscopic focal damage to involvement of the entire colon. […] Colonic ischemia results from occlusion of large vessels such as the mesenteric arteries or diseases or thromboemboli, which affect the intramural circulation with its smaller vasculature. […] Ischemia affects the colon more commonly than it affects the small bowel, probably because of the vast collateral vascular network that exists in the small bowel. […] Colonic regions with poor collateral circulation, particularly around the splenic flexure and the rectosigmoid, are especially vulnerable. […] The gross features of large intestinal ischemia resemble those of small intestinal ischemia. […] The changes vary depending on the severity and depth of the ischemic process, whether the event is acute or chronic, and the stage of healing that may have occurred. […] The features may mimic fulminant UC or toxic megacolon.

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