Ischemic colitis

In medicine, ischemic colitis is "inflammation of the colon due to colonic ischemia resulting from alterations in systemic circulation or local vasculature."

Signs and symptoms
Three progressive phases of ischemic colitis have been described:


 * A hyperactive phase occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.


 * A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.


 * Finally, a shock phase can develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.

Symptoms of ischemic colitis vary depending on the severity of the ischemia. The most common early signs of ischemic colitis include abdominal pain (often left-sided), with mild to moderate amounts of rectal bleeding. The sensitivity of findings among 73 patients were:
 * abdominal pain (78%)
 * lower digestive bleeding (62%)
 * diarrhea (38%)
 * Fever higher than 38°C (34%) (38°C equals approximately 100.4°F)

Physical examination
 * abdominal pain (77%)
 * abdominal tenderness (21%)

Diagnostic tests
Regarding blood tests, the sensitivity of tests among 73 patients were:
 * The white blood cell count was more than 15,000/mm3 in 20 patients (27%)
 * The serum bicarbonate level was less than 24 mmol/L in 26 patients (36%)

Plain X-rays are often normal or show non-specific findings. In a series of 73 patients, plain abdominal radiography (56%) showing colic distension in 53% or a pneumoperitoneum in 3%.

CT scans are often used in the evaluation of abdominal pain and rectal bleeding, and may suggest the diagnosis of ischemic colitis, pick up complications, or suggest an alternate diagnosis.

There are devices which test the sufficiency of oxygen delivery to the colon. The first device approved by the U.S. FDA in 2004 uses visible light spectroscopy to analyze capillary oxygen levels. Use during Aortic Aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. In several studies, Specificity has been 90% or higher for acute colonic ischemia, and 83% for chronic mesenteric ischemia, with a sensitivity of 71%-92%. This device must be placed using endoscopy, however. , ,