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:''This article concerns ischemia of the large bowel. See mesenteric ischemia for ischemia of small bowel''
'Ischemic colitis' (Ischaemic Colitis - British English) is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia^[1][2][3]. Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.^[4]
Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed via endoscopy. Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill.^[5]
Patients with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest (that is, no food or water by mouth) until the symptoms resolve. Those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture^[6] or chronic colitis.^[7]

Contents

Causes and epidemiology

Non-occlusive ischemia

Occlusive ischemia

Pathophysiology

Colonic blood supply

Development of ischemia

Pathologic findings

Diagnosis

Signs and symptoms

Diagnostic tests

Treatment

Prognosis

Long-term complications

References

Further reading

External links

Causes and epidemiology

The exact incidence of ischemic colitis is difficult to estimate, as many patients with mild ischemia may not seek medical attention. Ischemic colitis is responsible for about 1 in 2000 hospital admissions, and is seen on about 1 in 100 endoscopies.^[8] Men and women are affected equally; ischemic colitis is a disease of the elderly, with more than 90% of cases occurring in people over the age of 60.
Ischemic colitis is often classified according to the underlying cause. ''Non-occlusive'' ischemia develops because of low blood pressure or constriction of the vessels feeding the colon; ''occlusive'' ischemia indicates that a blood clot or other blockage has cut off blood flow to the colon.

Non-occlusive ischemia

In hemodynamic instable patients (i.e. shock) the mesenteric perfusion may be compromised. This condition is commonly asymptomatic, and usually only apparent through a systemic inflammatory response.

Occlusive ischemia

Mostly the result of a thromboembolism. Commonly the embolism is caused by atrial fibrillation, valvular disease, myocardial infarction, or