Ischemic bowel disease is caused by a compromise in the blood supply of the gut. Ischemic colitis is a relatively mild form of the condition, in which the disruption of blood flow is transient, necrosis is limited, and patients often recover in a couple of days with supportive care. Acute mesenteric ischemia can be due to either arterial or venous thrombosis and is a more serious ailment, with a relatively high rate of mortality.
Ischemic colitis is the most frequent manifestation of ischemic bowel disease. It is caused by a temporary reduction in the blood flow in small blood vessels. The symptoms are relatively mild, necrosis is restricted and rarely affects the full thickness of the gut; however, about 15% of cases will develop transmural necrosis and, as a result, peritonitis . On the other hand, acute mesenteric ischemia presents with severe pain and is often due to thrombosis or embolism. It may proceed to a compromise in the barrier function of the gut wall, leading to leakage into the peritoneum and systemic inflammation. Both ischemic colitis and mesenteric ischemia may be associated with a range of severity.
Ischemic bowel disease mainly affects the elderly. It may be induced by a variety of conditions, treatments, or medications. Physical exertion may lead to ischemia in the intestines. The ailment can follow vascular surgeries, such as aortic or cardiac bypass, and may be caused by inadequate perfusion during surgery or by ligation of the inferior mesenteric artery . Colonic ischemia is observed relatively frequently in abdominal aortic aneurysm (AAA) repair surgeries  and has been reported after placing a stent for AAA . Ischemic colitis can be a consequence of carcinoma or diverticulitis. Deficiencies of coagulation inhibitors (for example protein C) and other hypercoagulation disorders (factor V mutations, the antiphospholipid syndrome) occur in a high proportion of patients with colon ischemia . A large number of medications (for example antihypertensive drugs) may result in or contribute to ischemic colitis. Both arterial and venous thrombosis can be the main pathology responsible for acute mesenteric ischemia.
The initial symptoms of ischemic colitis are abdominal cramps (mainly on the left side), and an urge to defecate, followed by bloody stools - although there is no significant loss of blood. With care including bowel rest and fluid replacement, most patients recover within a couple of days. Surgery may be necessary in the presence of more advanced necrosis or if strictures develop. Severe necrosis will lead to the appearance of signs of peritonitis. Nausea, vomiting and some other findings indicate the development of ileus. Mesenteric ischemia begins with serious abdominal discomfort in the absence of any striking abnormality during a physical exam. Later in the course of the disease, features of peritonitis develop.
Entire Body System
- Weight Loss
Systemic signs such as fever, night sweats and weight loss may be present in advanced stages. Mesenteric lymphoma may involve the small bowel by direct extension or mass effect. [aischannel.com]
A second patient with Takayasu’s presented with a 4-month history of abdominal pain, a 50-pound weight loss, stenosis of all major mesenteric arteries, and bowel pneumatosis. [mdedge.com]
These blood clots in the small intestine and bowels can lead to: Weight loss Pain with eating Fear of food Left untreated over time, blockages can decrease blood flow so much that the tissues in your intestines die. [upmc.com]
WEIGHT LOSS CHRONIC mesenteric ischemia sometimes leads you to lose weight because, although you may feel hungry, you eat less or less frequently to avoid the pain. [vascular.org]
loss and malabsorption Bloating, nausea, occasional diarrhea Abdominal bruit caused by stenosis of mesenteric vessels A patient typically presents with postprandial abdominal pain ( abdominal angina ), food aversion, and weight loss! [amboss.com]
- Abdominal Pain
The majority of patients presented with the triad of abdominal pain, diarrhea and vomiting. In 13 patients the diarrhea was associated with the passage of bright red blood per rectum. [ncbi.nlm.nih.gov]
Chronic ischemia may masquerade asinflammatory bowel disease, with episodes ofbloody diarrhea interspersed with periods of healing. 53. [slideshare.net]
[…] cholesterol or peripheral artery disease) Bowel obstruction (something is stuck in the intestines) Scar tissue from surgery Tumor in the intestines Hernia The symptoms of ischemic bowel disease can include: Abdominal pain Blood in your bowel movements Diarrhea [mainlinehealth.org]
Transmural infarctions caused by acute vasoocclusive etiologies typically manifest with a sudden onset of extreme abdominal pain, characteristically out of proportion to the clinical signs, and bloody diarrhea which can be rapidly fatal if left untreated [pathwaymedicine.org]
He declined to eat and reported constipation. [theexpertinstitute.com]
Frequent constipation, hardening of the arteries, and low blood pressure are all conditions that may occur more often in old age and simultaneously increase your risk of ischemic colitis. High cholesterol can also be a factor. [doctorshealthpress.com]
Constipation is a more rare symptom compared todiarrhea and manifestation of this symptom depends on the allocation of ischemia. [lecturio.com]
[…] symptoms of acute intestinal ischemia are central abdominal pain (often out of proportion to the benign abdominal examination), weight loss (an important clue even in the acute presentation), bowel emptying, and altered bowel function (vomiting, bloating, constipation [accessmedicine.mhmedical.com]
Anorexia 53-54% 3. vomiting 41-77% 4. diarrhea 36%, constipation 13-34% 5. hematemesis 9-42% More insidious onset of symptoms Mesenteric venous thrombosis risk factors? 9 1. Hypercoagulable state (up to 75% have a hypercoagulable disorder) 2. [brainscape.com]
- Abdominal Distension
RESULTS: Abdominal pain, abdominal distension and bloody stool were major initial presentations. The mean age of the patients was 62.4 years at the time of diagnosis of ischemia. [ncbi.nlm.nih.gov]
distension, back pain and shock are late features indicating compromise of bowel viability Investigations WCC 15 in 75% metabolic acidosis in 50% plain AXR normal in early stages. [aic.cuhk.edu.hk]
Symptoms• Cramping and abdominal pain• Bloody stools• Frequent urge to defecate• Diarrhea• Nausea or vomiting• Abdominal distension 44. Ischemia bowel• acute or chronic.• arterial or venous• occlusive or nonocclusive. 45. [slideshare.net]
However, the test is often technically limited due to the presence of air-filled bowels, fluid and abdominal distension. [vasculardiseasemanagement.com]
Unfortunately, in the postoperative period, patient’s general condition was not getting better, recurred abdominal pain, vomiting and abdominal distension with radiological signs of ileus, increased inflammatory markers level. [journals.viamedica.pl]
- Abdominal Cramps
Her daughter says her mother also had episodes of nausea, vomiting, diarrhea, and abdominal cramps. Assessment hints Ms. Lister, who has a history of atrial fibrillation and peripheral vascular disease, has been recovering from a recent splenectomy. [americannursetoday.com]
The initial symptoms of ischemic colitis are abdominal cramps (mainly on the left side), and an urge to defecate, followed by bloody stools - although there is no significant loss of blood. [symptoma.com]
Symptoms common to this group of diseases may include: Diarrhea Vomiting Abdominal Cramping Rectal Bleeding Weight loss Additionally, these illnesses may be accompanied by other problems, such as arthritis, liver disease ( primary sclerosing cholangitis [disability-benefits-help.org]
Symptoms can include diarrhea with or without blood, abdominal cramps, and dehydration from water loss because of numerous watery, bowel movements. Other organs can also be affected by the infection or the toxins that the bacteria can produce. [medicinenet.com]
Patients with MVT present with a mixture of nausea, vomiting, diarrhea, and abdominal cramping. Gastrointestinal bleeding occurs in 10% [ 22 ]. [wjes.biomedcentral.com]
Blood volume redistribution with transient episodes of hypotension, especially during postoperative hemodialysis, may be significant. [ncbi.nlm.nih.gov]
[…] mucosal: extends down to the muscularis mucosa (hypotension) mural: involves the mucosa and submucosa (hypotension) transmural: involves all 3 wall layers (acute obstruction) What are the 2 phases of intestinal response to ischemia? 1. [quizlet.com]
Catastrophic hypotensive states naturally affect perfusion in all mesenteric vessels and atherosclerotic narrowing, when it does occur, is typically widespread and affects much of the mesenteric vasculature. [pathwaymedicine.org]
Some of them are obesity, prolonged smoking, colon cancer, atherosclerosis and hypotension, but also we can add some side effects from the use of medications. [ic.steadyhealth.com]
– When infarction occurs, increased pain associatedwith vomiting,hypotensive and tachycardic, withloose bloody stool. 23. 4.Mesenteric venous thrombosisin a much younger patient population than other types .– acute or subacute abdominal pain involvement [slideshare.net]
- Responsiveness Decreasing
Although the CHOP regimen is considered the gold standard for treatment of patients with DLBCL, the addition of rituximab results in a significant improvement of the outcomes, with an increased rate of full response, decreased treatment failure and relapse [aischannel.com]
Physical examination was significant for lethargy, dry mucous membranes, and grunting without increased work of breathing or adventitious lung sounds. His abdomen had normoactive bowel sounds, mild distention, generalized tenderness, and rigidity. [pediatrics.aappublications.org]
625 Fulminant Hepatic Failure 629 Adult Liver Transplantation Selection and Pretransplant Evaluation 638 Liver Transplantation Surgical Techniques Including Living Donor 644 Pediatric Liver Transplantation 650 Ascites and Its Complications 656 Hepatic Encephalopathy [books.google.com]
Among the imaging techniques, plain abdominal radiography is not sensitive enough to detect ischemic colitis but may indicate towards mucosal edema (thumbprinting), and intramural gas, as well as intraperitoneal gas if there is a perforation. It is also useful for ruling out other conditions. Barium enema also detects thumbprinting in the large majority of patients with ischemic colitis , but the technique is not widely used anymore. The techniques of choice are colonoscopy and computed tomography (CT). In the early stages, colonic edema with pale mucous membranes, and capillary hemorrhages are found by colonoscopy. In later stages, a single linear ulcer may be detected . In severe cases, the membranes look blue, gray or black. CT will show, among other features, symmetrical thickening of the wall, uneven narrowing of the lumen, and edema. A segmental distribution of anomalies is also characteristic of ischemic colitis , and is one of the features that tend to occur less in inflammatory bowel disease; thus it may be used to distinguish the two conditions. Ultrasound is not widely used but may indicate luminal thickening, edema, hemorrhage, and intramural gas .
Timely identification is crucial in the case of acute mesenteric ischemia because of the high mortality rates. Angiography is useful, but the clinical assessment is of primary importance.
[…] portalis : gas in the portal vein or in mesenteric vein can be differentiated by pneumobilia because gas usually reaches the periphery of the liver while pneumobilia is usually about 2 cm short of external liver border, and is more clustered at the hilum pneumoperitoneum [radiopaedia.org]
[…] non-specific findings, such as: bowel wall thickening, bowel dilation, mesenteric edema, ascites *pitfall : to assume alternate Dx like infectious colitis when you get the non-specific early findings of mesenteric ischemia Late CT Findings: pneumatosis, pneumoperitoneum [emergencymedicinecases.com]
[…] patients (27%) The serum bicarbonate level was less than 24 mmol/L in 26 patients (36%) Plain X-rays are often normal or show non-specific findings.  In a series of 73 patients, plain abdominal radiography (56%) showing colic distension in 53% or a pneumoperitoneum [en.wikipedia.org]
[…] intra-abdominal (eg, appendicitis, diverticulitis, or abscess) Venous congestion from cirrhosis (portal hypertension) Venous trauma from accidents or surgery, [38, 39, 40, 41, 42] especially portacaval surgery Increased intra-abdominal pressure from pneumoperitoneum [emedicine.medscape.com]
QT, RR, ST Intervals
What Is the Difference between Ischemic Colitis and Ulcerative Colitis? Ischemic colitis vs. ulcerative colitis. What is the difference? While both affect the bowel regions, the two different types of colitis do have some major differences. [doctorshealthpress.com]
How to Diagnose Ischemic Colitis Your doctor will utilize several different tests to properly diagnose ischemic colitis. [belmarrahealth.com]
Colonoscopy showed signs referring to acute ischemic colitis. Computed tomography detection of hepatic portal venous gas has permitted the non-invasive diagnosis of bowel necrosis. [ncbi.nlm.nih.gov]
Ischemic colitis, enteritis, or enterocolitis NOS ICD-9-CM Volume 2 Index entries containing back-references to 557.9 : [icd9data.com]
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