From the Guidelines
Ischemic colitis is diagnosed and treated with prompt surgical intervention and revascularization to restore blood flow to the affected area.
Diagnosis
The diagnosis of ischemic colitis is typically made using CT angiography to establish the diagnosis and evaluate the potential for revascularization 1.
- CT of the abdomen and pelvis should be performed in the non-contrast, arterial and portal venous phases to identify the underlying cause of ischemia and evaluate for possible bowel complications.
- MR angiography (MRA) can also be considered, but it is limited in its ability to evaluate for ischemic bowel changes.
Treatment
The treatment of ischemic colitis involves revascularization to re-establish blood flow to the ischemic bowel, resection of necrotic intestine, and damage control techniques when appropriate 1.
- Surgical treatment consists of laparotomy, revascularization of the ischemic intestine either by embolectomy or bypass grafting, assessment of the viability of the intestine after revascularization, resection of nonviable intestine, and intensive care.
- Scheduled “second look” operations, 24 to 48 hours after the initial procedure, are the best way to avoid both excessive resection of potentially viable bowel and failure to resect nonviable intestine 1.
Important Considerations
- Early diagnosis and timely surgical intervention are essential to reduce the high mortality associated with ischemic colitis.
- The mortality rate for acute intestinal ischemia caused by arterial obstruction is approximately 70% despite treatment 1.
- The use of percutaneous therapy should be weighed against surgical options in the presence of infarcted bowel or markedly elevated lactic acid levels 1.
From the Research
Diagnosis of Ischemic Colitis
- Ischemic colitis is typically diagnosed through a combination of clinical suspicion, radiographic, endoscopic, and histological findings 2, 3, 4, 5, 6
- Colonoscopy is considered the gold standard for diagnosis, and is often used in conjunction with histopathological biopsy 2, 5, 6
- Enhanced-CT is also a useful diagnostic tool, and can help to define the extent of ischemia 3
- MR may be used as an alternative to CT in certain cases, such as in patients with iodine allergy or renal dysfunction 3
Classification of Ischemic Colitis
- Ischemic colitis can be classified into two main forms: gangrenous and non-gangrenous 2, 4
- Non-gangrenous ischemic colitis can be further subdivided into transient and chronic types 2
- The classification of ischemic colitis is important, as it can help to guide treatment and predict outcomes 2, 4
Treatment of Ischemic Colitis
- The treatment of ischemic colitis depends on the severity of the disease 2, 3, 4, 5, 6
- Most cases of non-gangrenous ischemic colitis can be managed medically, and have a good prognosis 2, 4
- Gangrenous ischemic colitis, on the other hand, often requires urgent operative intervention and has a high morbidity and mortality 2, 4
- Supportive therapy is often the only treatment required for most cases of ischemic colitis 3
- Drug therapies such as phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide have been studied as potential treatments for ischemic colitis 5