Tohoku J. Exp. Med., 2009, 218(2)

Review

Ischemic Colitis: Surging Waves of Update

MICHAEL STAMATAKOS,¹ EMMANUEL DOUZINAS,² CHARIKLEIA STEFANAKI,¹ CONSTANTINA PETROPOULOU,¹ HELEN ARAMPATZI,³ CONSTANTINOS SAFIOLEAS,¹ GEORGE GIANNOPOULOS,¹ CONSTANTINOS CHATZICONSTANTINOU,⁴ CONSTANTINOS XIROMERITIS⁵ and MICHAEL SAFIOLEAS¹

¹Fourth Department of Surgery, Medical School, University of Athens, ATTIKON General Hospital, Athens, Greece
²Third Department of Critical Care, Medical School, Athens University, Eugenidion Hospital, Athens, Greece
³First Department of Obstetrics and Gynecology, Athens University Medical School, Alexandra Hospital, Athens, Greece
⁴Department of Radiology, General Hospital ‘St. Panteleimon', Nikaia, Greece
⁵First Department of Surgery, University of Athens Medical School, Laikon Hospital, Athens, Greece

Ischemic colitis is the most common type of intestinal ischemia, and it represents the consequences of acute or, more commonly, chronic blockage of blood flow through arteries that supply the large intestine. Ischemic colitis is manifested through a continuum of injury and considered as an illness of the elderly. The incidence of ischemic colitis has been underestimated, because many mild cases may go unreported. Patients experience abdominal pain, usually, localized to the left side of the abdomen, along with tenderness and bloody diarrhea. Severe ischemia may lead to bowel necrosis and perforation, which results in an acute abdomen and shock, frequently, being accompanied by lactic acidosis. Although computed tomography may have indicative findings, colonoscopy is the golden standard of diagnosis. 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. The condition resolves completely with conservative treatment, in most cases, but late diagnosis or severe ischemia can be associated with high rates of complications and death. However, when the interruption to the blood supply is more severe or more prolonged, the affected portion of the large intestine may have to be surgically removed. The present paper aims at bringing ischemic colitis up to date, by reviewing the current medical literature and extracting the contemporary data, about its presentation, diagnosis and treatment, which is of benefit to the readership, who may encounter this potentially fatal entity.

Keywords —— ischemic colitis; intestinal tract; atherosclerosis; colonic ischemia; colon.

© 2009 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2009, 218, 83-92

Correspondence: Michael Stamatakos MD. PhD. Fourth Department of Surgery, Medical School, University of Athens, ATTIKON General Hospital, 153 Aigyptou, ANO GLYFADA, 16562, Athens, Greece.

e-mail: stamatakosmih@yahoo.gr