[Acute regional colitis--ischemic colitis?].
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Abdomen, Acute↗
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[Pathophysiology and diagnosis of ischemic colitis].
Ischemic colitis is the most common manifestation of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops spontaneously. It is classified into the transient type, stricture type, and gangrenous type. The majority of patients with ischemic colitis, excluding the gangrenous type, follow a benign clinical course in the absence of major vasculature occlusion. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy and/or barium enema. Nongangrenous ischemic colitis usually requires only conservative therapy, including repeated careful assessment, pain control, and fluid replacement, and is associated with a good prognosis. It may lead to the sequela of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent surgery and high morbidity and mortality rates are hallmarks of the gangrenous type. Special consideration must be given to those patients in whom ischemic colitis develops in the context of colon cancer or obstructive colonic lesions. Successful management of a patient with ischemic colitis requires a high degree of clinical suspicion, early diagnosis, careful follow-up, and prompt recognition of persistent disease.
Colitis, Ischemic↗
[Age-related clinical features in ischemic colitis].
Ischemic colitis has been considered to have relatively high prevalence in the elderly population with underlying vascular disorder such as hypertension. However, this disease has been recently reported increased in the young population so that it is not necessarily limited to the aged. The aim of the present study was to elucidate the characteristics of age-related clinical features in ischemic colitis. The subjects consisted of 30 patients with ischemic colitis admitted to our hospital during the last 5 years. They were divided into the aged group more than 65 years old and the young group aged 65 or less. As a result, there were no significant differences in symptoms, resulted serological examination, endoscopic findings, and treatment period. Lesion sites were more extended in the aged group. Concerning underlying disease and etiologic factors, the vascular factor was important in the aged group, while the peristaltic factor, especially constipation was important in the young group. Ten of the 30 patients had habitual constipation, and the aged group had a high percentage of paralytic constipation, while the young group had a high rate of spastic constipation. Many patients with paralytic constipation had a history of underlying diseases and laparotomy, while the patients with spastic constipation did not have such a history. Therefore, it is presumed that the spastic type of constipation is an etiologic factor in ischemic colitis.
Adult↗
Ischemic colitis.
Ischemic colitis represents the most common form of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops "spontaneously," in the absence of major vasculature occlusion, and in the presence of viable intestine elsewhere. It is most usefully classified into gangrenous and nongangrenous forms, the latter of which may be subdivided into transient and chronic types. Ischemic colitis may develop in people who are otherwise healthy, although a variety of clinical settings, such as shock, predispose to its occurrence. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy. Therapy and outcome are dependent on the severity of disease. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis. The chronic subtype may lead to the sequelae of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent operative intervention and a high morbidity and mortality are the hallmarks of gangrenous colonic ischemia. Special considerations must be given to those patients in whom ischemic colitis develops in the context of colon carcinoma or obstructing colon lesions, after abdominal aortic surgery, and following cardiopulmonary bypass. This review will discuss the clinical spectrum of ischemic colitis.
Colitis, Ischemic↗
[Anatomic-pathologic diagnosis of ischemic colitis].
Ischemic colitis is caused by anoxia of the colonic and rectal wall due to defective regional blood supply. The pathology examination distinguishes acute obstructive and non-obstructive gangrenous ischemic colitis from chronic segmentary stenosing ischemia on the basis of the gross aspect and microscopic criteria and is necessary for differential diagnosis. Endoscopy, which is contraindicated in acute gangrenous ischemic colitis, provides a biopsy. Acute transitory ischemia can be distinguished from chronic stenosing colitis.
Arterial Occlusive Diseases↗
Spontaneous and shock-associated ischemic colitis.
Ischemic changes in the colon that progress to gangrene present diagnostic and therapeutic difficulties associated with poor survival. During the past 10 years, 36 patients with colonic ischemia were treated. Two clinical groups were evident. The spontaneous ischemic colitis group (type I) included 17 patients who were well before the onset of gastrointestinal symptoms. The cause of type I ischemic colitis is not apparent; it is attributed to occlusive or nonocclusive ischemia. The other group (type II) included 19 patients who developed ischemia of the colon associated with shock secondary to various disease processes. Radiographic evidence of distended bowel correlated well with full-thickness necrosis as determined clinically or pathologically. Twenty-one patients died, for a mortality rate of 58 percent. While full-thickness gangrene was fatal in 71 percent of the patients, mucosal necrosis only was associated with an 88 percent survival rate. The results of treatment should improve with an increased awareness of ischemic colitis, earlier appropriate operative intervention, and more appropriate use of ileostomy and colostomy.
Aged↗
Sonographic findings in methamphetamine-induced ischemic colitis.
Ischemic colitis is a clinicopathologic condition that commonly occurs in elderly patients with atherosclerotic disease or diabetes mellitus. Uncommon etiologies include vasculitis and use of drugs such as oral contraceptives, phenobarbital, nasal decongestants, dextroamphetamine, and cocaine. Recent studies have shown sonography and CT to be helpful in the evaluation of the colitides. We report the sonographic and CT findings in an unusual case of methamphetamine-induced ischemic colitis. Sonography and CT revealed diffuse thickening of the large bowel wall. Methamphetamine abuse should be considered in the differential diagnosis of the colitides, particularly in the setting of a young patient with a history of drug use and no other predisposing conditions.
Abdomen, Acute↗
[HLA-DR antigen expression on colonic epithelium of ulcerative colitis in comparison with infectious colitis and ischemic colitis].
We examined HLA-DR antigen expression on endoscopically biopsied colonic epithelium of ulcerative colitis (UC), infectious colitis and ischemic colitis. Since this monoclonal antibody (LN-3 ICN Immunobiological, USA) is available for usual formalin fixated materials, if the fixation is limited within 36 hours. 886 samples from 55 UC cases, 91 samples from 19 infectious colitis cases, 63 samples from 15 ischemic colitis cases and 63 samples from normal cases were enough statistically, compared to DR antigen expression. UC expressed clearly statistical high positive DR staining rate than infections colitis and ischemic colitis. Further, samples from UC and infectious colitis were compared in the histopathologically each with the same grade of inflammation, UC expressed higher positive rates of DR antigen than infectious colitis, and both UC and infectious colitis showed increased positive rates of DR antigen with advance of histopathological grades of inflammation.
Bacterial Infections↗
[Ischemic colitis and gangrenous ischemic colitis].
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Aged↗
[Ischemic colitis and gangrenous ischemic colitis].
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Aged↗
Role of platelet activating factor on severity of ischemic colitis.
PURPOSE: Ischemic colitis develops after a sudden decrease in colonic blood supply and has a variety of clinical manifestations. The aim of this study was to assess the role of platelet activating factor in the pathogenesis of ischemic colitis with use of the platelet activating factor antagonist TCV-309. METHODS: Rats were randomly divided into four groups. Rats in Group RV underwent ring attachment around the rectum to induce partial obstruction and ligation of the marginal vessels of the left colon. As control, rats in Group R underwent the ring attachment and rats in Group V underwent the vascular ligation. Rat in Group C underwent sham operation. The effects of TCV-309 on lesion formation in the colon were evaluated. Thiobarbituric acid reactant level was determined in colonic mucosa, and the incidence and severity of ischemic lesions were also determined. RESULTS: Lesions of colitis were frequently observed in Group RV. TCV-309 did not prevent lesion formation, nor did it suppress the increase in thiobarbituric acid reactant level in Group RV. However, TCV-309 mitigated the severity of the lesion. CONCLUSIONS: Partial obstruction of the colon tends to induce ischemic colitis, and additional ischemia completes lesion formation. Platelet activating factor may play a role in the progression of ischemic lesions.
Animals↗
Analysis of the clinical features of ischemic colitis.
Although ischemic colitis is not rare in the elderly with episodes of ischemia involving the heart and brain, clinical features of mild cases (transient type) have seldom been reported. Whereas the diagnostic findings of ischemic colitis are said to be longitudinal ulcers and stricture, longitudinal ulcers were noted only in 38% of the transient type in our series. For the correct diagnosis of the transient type, it was necessary to observe slight mucosal changes such as edema, congestion and petechiae by colonoscopy. It is emphasized that for the diagnosis of the mild transient type of ischemic colitis emergency colonoscopy must be performed as soon as possible after the onset of abdominal pain or rectal bleeding.
Adult↗
[Granulomatous colitis presenting as ischemic colitis].
The authors describe a case of granulomatous colitis mimicking a non gangrenous ischemic colitis. The radiological features are thumbprinting, ulcerations, then stenosis and sacculation. The resected specimen reveal some granuloma without necrosa.
Adult↗
Evidence of free radical (FR) involvement in ischemic colitis.
Early ischemic colitis was induced in rats to evaluate the roles of FRs and intraluminal content. After 30 minutes of ischemia, biopsies for histology, conjugated dienes (CD) and malonaldehyde (M), presumptive marker of lipid peroxidation, were obtained at 0, 30, and 60 minutes reperfusion. Histology was unchanged. CD and M were elevated in ischemic and saline controls, and rose progressively during reperfusion; CD and M were essentially the same as non-ischemic controls during reperfusion with intraluminal corticosteroid (c) and Alcide (A). These agents may be beneficial in early ischemic colitis.
Adrenal Cortex Hormones↗
[Cholesterol crystal embolization, a rare cause of postoperative ischemic colitis].
An ischemic colitis of the descending Colon and Sigma in 3 patients following aorto-iliacal reconstruction was caused by embolism of cholesterol crystals. In all cases the stump pressure of the inferior mesenteric artery measured more than 40 Torr as an empiric value. Therefore a good collateral blood flow could be expected. Nevertheless a malperfusion of the left Colon occurred. These cases of postoperative ischemic colitis were caused by multiple cholesterol crystal emboli in the arterioles of the colon descendens and Sigma. The mobilisation and embolism of arteriosclerotic material during aorto-iliac reconstruction must be responsible for the unfortunate event. Awareness of a bowel ischemia following abdominal aortic surgery and immediate endoscopic control should lead to an early diagnosis and a higher survival rate. A decision to redo operation with left hemicolectomy is required at an early stage.
Aged↗
Colitis in the elderly: ischemic colitis mimicking ulcerative and granulomatous colitis.
Eight patients over age 60 years had sudden onset of acute abdominal pain and rectal bleeding in the absence of prior inflammatory bowel disease. Several improved on medical therapy alone; those who required surgery suffered no recurrence up to 6 years. Although the pathologic specimens on these patients were first considered to represent ulcerative colitis or Crohn's disease, their histories and clinical courses are much more consistent with ischemic colitis. Since there are only a limited number of reactions that the bowel can muster against a host of damaging processes, histologic criteria alone are usually not sufficient to separate ischemic disease of the colon from ulcerative colitis and Crohn's disease. This is also true of radiographic features. Thus the diagnosis of ischemic colitis rests on clinical onset and course after treatment.
Aged↗
Intraoperative photoplethysmographic diagnosis of ischemic colitis.
Intraoperative evaluation of ischemic colitis presents several problems related to diagnosis, severity, and extension. The aim of this study was to determine the usefulness of photopletysmography (PPG) to detect colonic arterial wave amplitude changes in patients operated on for ischemic colitis, comparing the affected area with a control area on the transverse colon. Four patients were studied, two with gangrenous colitis, and two with protracted "transient" ischemic colitis. All four patients survived. PPG is a useful method for intraoperative diagnosis and surgical assessment of ischemic colitis.
Aged↗
[Clinical features of 27 cases of ischemic colitis (author's transl)].
The Authors report own experience of ischemic colitis, related to 27 cases, that includes either primitive forms (transient ischemic colitis, ischemic stricture and necrotic-gangrenous ischemic colitis) or secondary (occlusive ischemic colitis, ischemic colitis following abdominoperineal excision of the rectum). Pathogenetic findings, now not completely defined, are discussed with reference to the literature on this subject. The important diagnostic problems are also evaluated, particularly in the evaluation of radiologic and endoscopic findings of spontaneous ischemic colitis; these, altogether, represent an almost specific clinical picture of ischemic colitis. At last are considered the problems related to surgical treatment, overall in the forms in which the irreversibility of the ischemic lesions has been ascertained.
Aged↗