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Ischemic colitis is generally associated with pain in the lower left abdominal region. Ischemic colitis is noted more commonly in individuals aged above 50 years, while younger individuals are also affected in certain instances.

What is ischemic colitis?

Ischemic colitis is a condition characterized by swelling of certain portions of the colon (large intestine) that arises due to reduced blood supply. Ischemic colitis is generally associated with pain in the lower left abdominal region.

The reduction in blood supply to the colon may occur abruptly or occur over a prolonged period of time. Ischemic colitis is noted more commonly in individuals aged above 50 years, while younger individuals are also affected in certain instances.

Underlying disorders and certain factors such as high cholesterol levels can increase the risk of ischemic colitis. Referred to as one of the common disorders of the intestines resulting from decreased blood supply, ischemic colitis is responsible for one in every 1000 hospitalizations related to intestinal disorders.

What are the causes of ischemic colitis?

Ischemic colitis occurs mainly due to a reduction or obstruction in the blood supply to the cells and tissues of the colon. The reduction in blood supply may be associated with a wide variety of reasons.

Clots formation in the blood vessels

Abrupt occurrence of ischemic colitis may be due to the formation of clots in the blood vessels that supply the colon. This results in a sudden obstruction in the blood supply leading to the symptoms of ischemia. In cases of long standing conditions, the blood supply to the colon is reduced gradually owing to a condition known as atherosclerosis. This condition is characterized by accumulation of fats along the walls of the blood vessels that reduce the amount of blood flowing through the blood vessels.

Certain medical conditions

Ischemic colitis can also arise as a result of certain underlying medical conditions. These include inflammatory conditions of the blood vessels (referred to as vasculitis), block in the blood vessels due to hernias, heart failure, low blood pressure, elevated blood sugar levels (diabetes mellitus), and cancer of the colon.

Surgery and radiation

Surgery involving the colon and radiation therapy to the abdominal region can also result in the reduction of blood supply to the colon in certain instances. Chronic smoking, high blood pressure and elevated cholesterol levels in the body are some of the factors associated with increased risk of ischemic colitis.

Prolonged use of certain drugs

Prolonged use of certain medicines that belong to the group of pain killers (NSAIDs), hormone replacement drugs, anti-hypertensives and anti-psychotics are also associated with an increased risk of ischemic colitis.

Infections

Infections of the colon may also trigger ischemia (restriction of blood supply) in the colon in some rare instances. 

What are the signs and symptoms of ischemic colitis?

Pain

Ischemic colitis is commonly associated with pain in the abdominal region. The area over the affected region may be painful to touch. The pain is generally noted in the lower left side of the abdomen. Pain may appear either abruptly or may tend to persist for long duration of time. Low fever may be noted in few cases and may indicate the presence of an infection.

Blood in the stool

Presence of blood in the stool may be indicated by the bright red color of the stools. In some instances diarrhea may be noted.

Vomiting

Vomiting is also associated with ischemic colitis in certain cases.

Weight loss

Some affected individuals may notice pain in the upper abdominal region after consumption of food which may make them avoid food for the fear of pain. Such individuals often tend to suffer from weight loss due to decreased consumption of food.  

How ischemic colitis is diagnosed?

The diagnosis of ischemic colitis is based on the signs and symptoms observed, physical examination and certain specialized tests such as colonoscopy (viewing the colon with a tube like device with a tiny camera). Additional tests may be advised in certain instances to rule out the presence of other underlying conditions or disorders.

How is ischemic colitis treated?

The treatment of ischemic colitis is based on the severity of the condition. While mild cases may require the administration of certain medications, moderate to severe cases may require you to get admitted to the hospital for a complete care.

Medications

Mild cases of ischemic colitis respond well to the medications that are prescribed. Drugs to control or restore the blood pressure to normal levels are commonly prescribed for mild cases. This improves the blood flow to the colon and minimizes the symptoms of ischemia. Additionally the doctors may prescribe antibiotic medications if any underlying infection is suspected. Other medications based on the presence of underlying disorders are also advised if these underlying disorders are suspected to be the cause of ischemic colitis.

Moderate to severe cases require the hospitalization of the affected individuals. The main aim of hospitalization in cases of ischemic colitis is to allow adequate rest to the colon so that it recovers faster. This is accomplished by avoiding food and liquid intake through the mouth. Fluids and other essential nutrients are provided through the vein (intravenous administration) during this period. Additionally certain medications may also be administered through the veins to help you recover faster. Mild to moderate cases of ischemic colitis respond well to this treatment within 1-2 weeks.

Surgery

Severe cases or long term (chronic) cases of ischemic colitis wherein permanent damage to the affected portions of the colon is suspected or diagnosed on colonoscopy require surgical removal of the affected portions. Surgery is also advised in cases where the symptoms of ischemic colitis fail to resolve following the administration of medications and restriction of oral intake of foods. In some instances the presence of bleeding ulcers (sores), perforation in the colon or gangrene (dead tissue) can also be the indication for surgical removal of the affected portions of the colon.

Read More: Persistent pain in the upper abdomen: Dyspepsia (Indigestion) Symptoms and Treatment

What is the prognosis of ischemic colitis?

While, mild cases of ischemic colitis improve on their own or with the administration of medications; moderate to severe cases of ischemic colitis need prompt medical attention to prevent complications. In general, majority of the individuals affected with ischemic colitis recover well within a period of 1-2 weeks. If left untreated, ischemic colitis can result in permanent damage to the colon and life threatening situations in certain situations.

What are the chances of recurrence of ischemic colitis?

Ischemic colitis is relived following proper care and appropriate treatment and generally does not recur. However, adequate care of underlying medical conditions such as heart disorders, low/high blood pressure, diabetes and other disorders need to be managed appropriately to prevent the recurrence of ischemic colitis.

  • www.mayoclinic.com/health/ischemic-colitis/DS00794
  • www.merck.com/mmhe/sec09/ch132/ch132h.html
  • www.nlm.nih.gov/MEDLINEPLUS/ency/article/000258.htm