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Ischemic colitis is a condition in which the colon becomes inflamed due to reduced blood flow, or ischemia, to the affected area. When tissues are deprived of oxygen, they can become damaged, which prompts the body’s response of inflammation. This inflammation can lead to discomfort, swelling, and bleeding, but it is a natural part of the healing process. Ischemic colitis primarily affects the mucosa, or inner lining, of one section of the colon. However, in cases of more severe or prolonged ischemia, the damage may extend deeper into the colon.
Misdiagnosis can occur with ischemic colitis since its symptoms can resemble those of other gastrointestinal issues. Treatment may involve medication to manage the condition or prevent infection, while surgery may be necessary if the colon sustains significant damage. Typically, ischemic colitis tends to resolve without intervention.
Symptoms
When symptoms occur on the right side of the abdomen, the risk of severe complications is increased compared to left-sided colitis, which is less common. People with right-sided colitis may have more underlying medical conditions, including high blood pressure, atrial fibrillation, and kidney disease. They may require surgery more frequently and have a greater risk of death.
Common symptoms of ischemic colitis may include:
- Cramping and pain in the abdomen
- Soreness in the abdomen
- Nausea
- Vomiting or loss of appetite
- Diarrhea and urge to defecate
- Passing stool with blood or blood alone
- Low-grade fever
Ischemic colitis is frequently misdiagnosed because it is easily confused with other digestive issues. If the signs and symptoms become persistent, consult a doctor immediately. It may be a medical emergency if there is an intense abdominal pain or blood in the stool. Early detection and treatment can assist to avoid serious problems.
Causes
Ischemic colitis may not have a clearly identifiable cause for reduced blood flow to the colon, but there are several factors that increase the risk of developing it. These factors include:
- Atherosclerosis, the accumulation of fatty deposits on the arterial walls.
- Disorders affecting the circulatory system, such as the heart and blood vessels, might result in decreased blood flow in the arteries that supply the colon. One of them could be obstructed by a blood clot, or it could be compressed from the outside.
- Hypotension, or low blood pressure, caused by dehydration, heart failure, surgery, trauma, or shock.
- Obstruction of the bowel caused by a hernia, scar tissue, or a tumor.
- History of surgery on the heart, blood vessels, digestive, or gynecological systems.
- Cocaine or methamphetamine consumption
- Colon cancer
- Blood-related medical conditions, such as vasculitis, lupus or sickle cell anemia
- Physical triggers such as colds
- The role of medications although uncommon, some medicines can induce low blood pressure which can lead to ischemic colitis, such as:
- Heart and migraine medications
- Hormone treatments, such as estrogen
- Antibiotics
- Pseudoephedrine
- Opioids
- Some irritable bowel syndrome medications
- Chemotherapy drugs
Risk factors
Several factors can affect one’s risk of developing ischemic colitis, such as:
- Age: It primarily affects adults over the age of 60. In a young adult, ischemic colitis could be a symptom of other medical condition such as a blood clotting disorder or vasculitis.
- Sex: Women are more likely to develop ischemic colitis.
- Blood clotting issues: The most frequent genetic disorders that increase the risk of blood clotting are Factor V Leiden and prothrombin gene mutation (G20210A). These disorders may increase the risk of ischemic colitis.
- High cholesterol: can contribute to atherosclerosis which can disrupt blood flow to the colon and lead to ischemic colitis.
- Reduced blood flow: due to some illnesses, such as diabetes or rheumatoid arthritis. It can also be a result of cardiac failure, low blood pressure, or shock.
- History of abdominal surgery: Blood flow may be restricted by scar tissue incurred after an abdominal surgery.
- Heavy exercise: Strenuous exercise, such as marathon running can cause ischemic colitis by straining the heart’s ability to pump adequate blood. This is commonly known as “runner’s colitis”.
- Surgery: The aorta or main artery can increase the risk of developing ischemic colitis. The aorta transports the blood from the heart to the rest of the body.
Diagnosis
Because the symptoms of ischemic colitis are common and generic, healthcare providers may need to rule out a number of other probable reasons before reaching a diagnosis. It is frequently confused with other illnesses, particularly inflammatory bowel disease (IBD). The following tests may be required to diagnose ischemic colitis:
- Abdominal computed tomography (CT) scans: is performed to help rule out other medical conditions including IBD. This procedure provides photos of the colon necessary for analysis.
- Colonoscopy: In colonoscopy imaging, ischemic colitis exhibits different features. It generates comprehensive images of the colon which can aid in the diagnosis of ischemic colitis. Colonoscopy can also be performed to screen for cancer and assess how well a treatment worked. Tissue samples can be taken through colonoscope.
- Stool analysis: to check for blood and screen out infection that may be causing the symptom.
- Blood test: A sample of the blood may be taken to screen for infections or other factors. Colitis in general may manifest as an elevated white blood cell count in a blood test.
Treatment
The course of treatment for ischemic colitis will depend on the severity of the condition and whether there are any complications present, such as an infection in the abdominal cavity. If the case is severe or complicated, emergency surgery may be necessary.
Medical management is the primary course of treatment for most cases. The healthcare provider may administer intravenous fluids and broad-spectrum antibiotics to prevent or treat infections. Oxygen therapy may be necessary to boost cardiac output and enhance blood flow. Any medications that aggravate ischemic colitis will be discontinued by the healthcare provider. Bowel rest is recommended, which involves abstaining from using the digestive system to promote healing. A liquid diet or intravenous nutrition may be prescribed.
There are several possible methods of treatment for ischemic colitis, including:
- Nasogastric (NG) tube: The use of a nasogastric tube to decompress the stomach. This may be necessary if part of the colon has become paralyzed.
- Treatment of blood vessels: Depending on the cause of the condition, a healthcare provider may need to surgically remove a blockage in an artery or use techniques to dissolve a blood clot or place a stent in a narrowed blood vessel.
- Colectomy: In cases where there is tissue death or rupture in the colon wall, it may be necessary to remove the affected portion of the colon. This may involve a temporary or permanent colostomy.
