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14 - Acute ischaemic colitis

Vish Bhattacharya
Queen Elizabeth Hospital, UK
Gerard Stansby
Freeman Hospital, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
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Key points

  • Acute ischaemic colitis can be due to occlusive or non-occlusive causes

  • A high index of suspicion should be present in elderly patients presenting with sudden abdominal pain and bloody diarrhoea

  • Computed tomography (CT) scan may show a ‘halo sign’ and also rule out other abnormalities

  • D-Lactate is more specific for intestinal ischaemia than L-Lactate

  • Angiography and lysis may be considered in early cases with no sign of peritonitis

  • In case of bowel resection primary anastomosis is best avoided and a re-look laparotomy recommended

  • Postaneurysm repair colitis can be prevented by selective reimplantaion of the inferior mesenteric artery (IMA) in high risk cases


Ischaemic colitis is the result of an event that leads to a reduction in colonic blood flow sufficient to cause ischaemia or infarction of the colonic wall but not sufficient to produce full thickness infarction and perforation.

The term ischaemic colitis was first introduced by Marston et al. in 1966. It is commonly due to acute thrombosis or embolism of the superior mesenteric artery (SMA) or IMA, causing compromise of the colonic blood supply or due to hypotension causing hypo­perfusion and ischaemia.

The term is often used for cases where full thickness infarction is present acutely but this usage is incorrect – not all ischaemic colons have ischaemic colitis, although the two may coexist if the involvement is patchy.


The following causes predispose the colon to ischaemia more readily than the small bowel:

  1. The colon differs from the small bowel in having no villi and therefore no countercurrent mechanism.

  2. […]

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 164 - 171
Publisher: Cambridge University Press
Print publication year: 2011

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Marston, A, Pheils, MT, Thomas, ML, Morson, BC.Ischaemic colitis. Gut 1966; 7: 1–15.CrossRefGoogle ScholarPubMed
Kvietys, PR, Granger, DN. Physiology, pharmacology and pathology of the colonic circulation. In: Shepherd, AP, Granger, DN, eds. Physiology of the Intestinal Circulation. New York: Raven Press, 1984.Google Scholar
Mann, Jr, Kessel, ER, Mullins, DL, Lottenberg, R.Ischemic colitis and acquired resistance to activated protein C in a woman using oral contraceptives. Am J Gastroenterol 1998; 93: 1960–2.CrossRefGoogle Scholar
Lucas, W, Schroy, PC 3rd. Reversible ischaemic colitis in a high endurance athlete. Am J Gastroenterol. 1998; 93: 2231–4.CrossRefGoogle Scholar
Welch, M, Baguneid, MS, McMahon, RF et al. Histological study of colonic ischaemia after aortic surgery. Br J Surg 1998; 85: 1095–8.CrossRefGoogle ScholarPubMed
Dignan, CR, Greenson, JK.Can ischaemic colitis be differentiated from C difficile colitis in biopsy specimens?Am J Surg Pathol 1997; 21: 706–10.CrossRefGoogle Scholar
Longo, WE, Ward, D, Vernava, AM 3rd, Kaminski, DL.Outcome of patients with total colonic ischaemia. Dis Colon Rectum 1997; 40: 1448–54.CrossRefGoogle Scholar
Fanti, L, Masci, E, Mariani, A et al. Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery? Results of a prospective trial. Ital J Gastroenterol Hepatol 1997; 29: 357–60.Google ScholarPubMed
Seeger, JM, Coe, DA, Kaelin, LD, Flynn, TC.Routine reimplantation of patent inferior mesenteric arteries limits colon infarction after aortic reconstruction. J Vasc Surg 1992; 15: 635–41.CrossRefGoogle ScholarPubMed
Killen, DA, Reed, WA, Gorton, ME et al. Is routine postaneurysmectomy hemodynamic assessment of the inferior mesenteric artery circulation helpful?Ann Vasc Surg 1999; 13: 533–8.CrossRefGoogle ScholarPubMed

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