Related Subjects:
|Metabolic acidosis
|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Renal Tubular Acidosis
|Lactic acidosis
Ischaemic colitis usually resolves but carefully observe as can progress to gangrene and peritonitis or stricture formation
About
- Ischaemia of the colon due to impaired blood supply
- Colon supplied by superior (SMA) and inferior mesenteric arteries (IMA)
- Watershed area is splenic flexure
Aetiology
- Thrombosis/Embolism/Vasculitis/Spasm/Low flow
- Atrial fibrillation, Atherosclerosis e.g. atheroma in IMA
- Mucosal ischaemia, inflamed, necrotic and ulceration and perforation
- Splenic flexure commonly affected at the watershed between SMA and IMA
Clinical
- Crampy abdominal pain, vomiting, diarrhoea (may be bloody)
- Abdominal distension, fever, tachycardia
- Gut claudication in more subacute or chronic cases
- Recurrent gastroenteritis picture in more subacute or chronic cases
- Localised peritonism on exam
Complications
- Sepsis, Peritonism, Perforation, Toxic megacolon
- Late: Stricture formation usually at splenic flexure of the colon
Investigations
- FBC ? WCC ? CRP ? Lactate ? CK
- ABG : metabolic acidosis
- AXR : normal and then later shows dilatation
- Stool culture if diarrhoea and diagnostic uncertainty
- Barium enema in subacute presentations - thumb printing due to submucosal swelling
- CXR - air under diaphragm if perforation
- CT scan may show thickened colonic wall, intramural air
- Colonoscopy without bowel preparation
Management
- Fluid and general resuscitation ABC. Consider starting UFH.
- Antibiotics as per local policy (Cefuroxime and Metronidazole)
- NG tube and suction if nil orally
- Many settle conservatively
- Surgery is laparotomy and resection and exteriorisation of affected bowel ends.
- Primary anastomosis is contraindicated. Mortality is high.