Ischaemic Colitis

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.