Ischemic colitis - causes, signs, treatment. Why is ischemic colitis dangerous? Ischemic colitis diagnostics

Caused by inadequate blood supply, is the most common manifestation of intestinal ischemia (60%). The severity depends on the location and prevalence, the severity of the onset of the disease, the presence of collaterals and the level of vascular occlusion: the most vulnerable are the splenic flexure, rectosigmoid junction and the right colon. Many different etiological factors lead to common pathological changes:

Vascular occlusion:
- Occlusion of large vessels: infrarenal aortic shunt, SMA thrombosis/embolism, portal vein thrombosis/SMA, trauma, acute pancreatitis, aortic dissection.
- Peripheral vascular occlusion: diabetic angiopathy, thrombosis, embolism, vasculitis, amyloidosis, rheumatoid arthritis, radiation injuries, trauma, embolization during interventional radiological procedures (in case of bleeding from the lower gastrointestinal tract), hypercoagulable state (deficiency of proteins C and S, antithrombin III , sickle cell anemia).

Non-occlusive diseases:
- Shock, sepsis, decreased perfusion (eg, atrial fibrillation, myocardial infarction, heart-lung machine), steal phenomenon, increased intra-abdominal pressure syndrome.
- Colon obstruction, intussusception, hernia.
- Intoxication: cocaine, drugs (NSAIDs, vasopressors, digoxin, diuretics, chemotherapy drugs, gold compounds).

Attention: Patients may have other significant pathological changes (eg, cancer) in affected or unaffected areas.

Treatment varies from conservative management (mild and moderate forms) to segmental resections and even colectomy (severe or life-threatening forms).

a) Epidemiology of ischemic colitis:
The peak incidence occurs between 60 and 90 years of age. Women are affected more often than men. Cause of emergency hospitalization in 1 in 2000 cases.
The true incidence is unknown due to misdiagnosis. Previously, up to 10% of ischemic colitis was caused by prosthetics of the infrarenal aorta, less often by interventional manipulations under X-ray control.
Localization: 80% - in the left sections (between the splenic flexure and the sigmoid colon), 10-20% - in the descending or transverse colon,<3% - в прямой кишке.

b) Symptoms of ischemic colitis

Acute ischemia:
Initial stage: acute ischemia => acute onset of abdominal pain, possibly spastic, hyperperistalsis, may be accompanied by diarrhea and urge to defecate.
Second stage: beginning tissue necrosis (after 12-24 hours) => paresis, paradoxical decrease in pain, bleeding (unchanged blood in the stool), mild peritoneal symptoms.
Third stage: peritonitis, sepsis - increased peritoneal symptoms, signs of intoxication (fever, leukocytosis with a shift to the left, tachycardia); complete paresis, nausea, vomiting, unstable hemodynamics, septic shock.
Complications:
- Dilatation of the colon and changes in the wall => perforation, sepsis, oliguria, multiple organ failure, death.
- Sepsis -> bacterial colonization of implants placed due to ischemia (e.g. prosthetic valves, aortic prostheses, etc.)

Chronic ischemia:
Angina abdominalis ("abdominal toad"): pain after eating as a result of insufficient blood flow to the intestines.
Strictures due to ischemic colitis => symptoms of obstruction.

in) Differential diagnosis of ischemic colitis:
- IBD: ulcerative colitis,.
- Infectious colitis: Shigella, enterohemorrhagic E.coli, Salmonella, Campylobacter, etc.
- Colorectal cancer.
- Diverticulosis, diverticulitis.
- Radiation proctitis.
- Other causes of acute abdominal pain and / or bleeding from the lower gastrointestinal tract.

G) Pathomorphology
Macroscopic examination:
Acute ischemia: swelling of the entire wall or only of the intestinal mucosa => area of ​​ulceration and necrosis, segmental full-walled necrosis => segmental gangrene.
Chronic ischemia: fibrous stricture, the mucosal surface is intact.

microscopic examination:
Acute ischemia: superficial mucosal necrosis (crypts are initially intact) => hemorrhages and pseudomembranes => transmural necrosis (loss of nuclei, cell shadows, inflammatory response, disruption of cellular architectonics); possible presence of visible blood clots, emboli, cholesterol emboli.
Chronic ischemia: mostly intact mucosa, but there is atrophy of the crypts and focal erosions, thickening/hyalinosis of the lamina propria, diffuse fibrosis.

e) Examination for ischemic colitis

Required minimum standard:
Anamnesis:
- Recent vascular surgery, embolism, "abdominal toad", a history of vasculitis, taking medications (including warfarin, acetylsalicylic acid).
- Triad of symptoms: acute abdominal pain, blood from the rectum, diarrhea.

Clinical examination:
- The main indicators of the state of the body: arrhythmia (atrial fibrillation), the stability of hemodynamic parameters?
- Bloating, abdominal pain inconsistent with clinical findings, hyperperistalsis or paresis, peritoneal symptoms?
- Preservation of the pulse on the femoral arteries and distal vessels of the extremities? Signs of widespread atherosclerosis?

Laboratory tests: blood => leukocytosis, anemia, thrombocytopenia (?), lactic acidosis, creatine kinase-BB, hypophosphatemia, coagulopathy, hypoproteinemia?

Radiation Imaging Methods:
- Abdominal/thoracic x-ray: free gas, "finger impression" sign, loss of haustration, dilated loops.
- CT with oral/IV contrast if possible (kidney function!): most practical if pain is the primary symptom => free gas in the abdomen, segmental bowel wall thickening, "finger impression" sign, pneumatosis, loss of haustration, dilatation loops, "double halo" symptom, gas in the portal vein? Other causes of abdominal pain? The state of the main ways of vascular outflow: blood clots?

Colonoscopy- "gold" standard: the most sensitive method, contraindicated in the presence of peritoneal symptoms: normal rectum (in the absence of complete occlusion of the aorta); segmental changes in the mucosa => hemorrhages, necrosis, ulcers, vulnerability? Strictures?

Additional studies (optional):
X-ray contrast studies are usually not indicated in an acute situation (usual signs: a symptom of "finger impressions", edema of the intestinal wall, loss of haustration, ulcers); chronic ischemia => bowel shape, stricture?
Visceral angiography (interventional, eg, thrombolysis): relatively limited role in the acute setting, except in cases of possible successful thrombolysis; assessment of symptoms of chronic ischemia -» vascular architectonics.

e) Classification of ischemic colitis
- Based on etiological factors: occlusive/non-occlusive ischemia.

Based on pathological changes:
Gangrenous ischemic colitis (15-20%).
Non-gangrenous ischemic colitis (80-85%):
- Transient, reversible (60-70%).
- Chronic irreversible => chronic segmental colitis (20-25%) => stricture (10-15%).

and) Treatment without surgery for ischemic colitis:
Recovery of hemodynamic parameters: volume replacement is more important than the use of vasopressors.
Broad-spectrum antibiotics, a series of clinical studies with periods of "rest" for the colon.
Heparinization, if tolerated.
Possibly interventional radiology.
Repeat colonoscopies: monitor the effectiveness of treatment, re-examination of the colon under optimal conditions to detect other pathological changes.

h) Surgery for ischemic colitis:

Indications:
Acute ischemia: peritonitis, pain inconsistent with clinical examination data, signs of gangrene, sepsis refractory to treatment, pneumoperitoneum; lack of improvement, persistent protein loss due to pathological changes in the intestine (lasting > 14 days).
Chronic ischemia: recurrent sepsis, symptomatic colonic stricture, any stricture in which the presence of a tumor cannot be ruled out.

Surgical approach:
1. Acute ischemia:
Resection of the affected segment => intraoperative assessment of the viability of the colon: bleeding from the edges of the mucosa, venous thrombi, the presence of a palpable pulse?
- Primary anastomosis or stoma (for example, double-barreled).
- Controversial viability: planned relaparotomy or more extensive resection.
Exploratory laparotomy if the area of ​​necrosis is too large and incommensurable with life.

2. Chronic ischemia:
Resection of the affected segment with the formation of a primary anastomosis.
Vascular interventions and subsequent reconstruction are possible.

and) Results of treatment of ischemic colitis:
Transient ischemia: relatively good prognosis, largely dependent on prognosis in other organs; 50% of cases are reversible, clinical resolution within 48-72 hours, resolution of the endoscopic picture within 2 weeks; in more severe forms, healing is prolonged (up to 6 months) => stricture?
Gangrenous ischemia: lethality in 50-60% of cases - the population of patients with concomitant diseases and with the most severe course of the disease!
Chronic ischemia: morbidity and mortality are similar to those of colon resection for other diseases, but there is a higher risk of cardiovascular complications.

to) Observation and further treatment:
Full examination of the intestine after 6 weeks (if the condition allows).
Emergency surgery: planning further interventions, i.e. restoration of intestinal continuity in a planned manner, after a complete restoration of physical condition and nutrition.
Determination of the variant and duration of anticoagulant therapy.

There are factors that cause inflammation of the large intestine and, as a result, ischemic colitis. This disease is relatively rare, but among the elderly it is determined most often. In most cases, after appropriate treatment, patients recover, but sometimes death occurs due to the development of sepsis.

Ischemic colitis (IC) is a disease in which inflammation and damage to the colon is the result of insufficient blood supply. IR can contribute to the occurrence of ischemic necrosis of varying severity, which often varies from superficial mucosal to transmural necrosis of the colon.

Marston et al. first used the term "ischemic colitis" in a paper published in 1966. This report was preceded by a description of reversible vascular occlusion of the large intestine, which was made by Boli and his colleagues in 1963.

Ischemic colitis is usually suspected based on the clinical presentation, physical examination, and laboratory findings. Additionally, the diagnosis can be confirmed by endoscopy or the results of using a sigmoid or endoscopic spectroscopic catheter with illumination. Most patients fully recover after CPB. Occasionally, after severe ischemia, patients may develop long-term complications such as stricture or chronic colitis.

Video Colitis. Colon disease

Description

The term "colitis" (Latin colitis) comes from the Greek. kolon - large intestine and Greek. itis is an inflammatory process. The definition of "ischemic" indicates a violation of normal blood circulation, as a result of which nutrition and oxygen transmission to the cells of an organ, in this case, the colon, suffer.

Normally, the large intestine receives blood from the superior and inferior mesenteric arteries. The circulatory network of these two main vessels is a fairly large area with abundant collateral circulation. Impaired blood flow causes damage to the lining of the colon, causing ulcers/erosions and bleeding.

Development of ischemia

Under normal conditions, the colon receives 10% to 35% of total cardiac output. If blood flow to the intestine is reduced by more than 50%, ischemia will develop. The arteries feeding the intestine are very sensitive to vasoconstrictors; this appears to be an evolutionary adaptation to redirect blood from the intestines to the heart and brain during times of stress. As a result, when blood pressure is low, the arteries that feed the large intestine constrict excessively. A similar process may result from the action of vasoconstrictor drugs such as ergotamine, cocaine, or vasopressors. This vasoconstriction can lead to non-occlusive ischemic colitis.

The following sections of the colon are most susceptible to ischemia:

• area of ​​the splenic angle
• descending colon
• upper rectum

The severity of ischemic colitis

With ischemic colitis, various signs may develop, indicating an appropriate clinical severity.

• Mild - mucosal and submucosal hemorrhages and edema are visible, possibly with mild necrosis or ulceration.
• Moderate - there is a pathological picture resembling inflammatory bowel disease (i.e., chronic ulcers, abscesses, and pseudopolyps).
• Severe - a transmural infarction with resulting perforation is determined. After recovery, the muscle tissue may be replaced by connective tissue, resulting in a stricture. Also, after restoration of normal blood flow, reperfusion injury can contribute to damage to the colon.

Facts and statistics on ischemic colitis:

• The disease is determined in one patient out of 2000 hospitalized, and is also observed in approximately one patient out of 100 endoscopically examined.
• More than 90% of cases occur in people over 60 years of age, so ischemic colitis is considered a disease of the elderly.
• Men and women suffer from IC equally often.

The reasons

There are two main causes of ischemic colitis, according to which the disease is classified into non-occlusive ischemic colitis and occlusive.

Non-occlusive ischemia develops due to insufficient blood pressure or narrowing of the vessels that feed the colon. Occlusive ischemia is due to the fact that a blood clot or other pathological component has blocked the access of blood to the colon.

Non-occlusive ischemia

In patients who are hemodynamically unstable (i.e., in shock), mesenteric perfusion may be impaired. This condition is usually asymptomatic and manifests only with a systemic inflammatory response.

Occlusive ischemia

It mainly develops as a result of thromboembolism. An embolus enters the blood supply of the colon, usually with atrial fibrillation, valvular disease, myocardial infarction, or cardiomyopathy.

In addition, ischemic colitis is a common complication of rehabilitation therapy after an abdominal aortic aneurysm, when the formation of the inferior mesenteric artery is closed with an aortic graft.

In a 1991 review of 2137 patients, the most common cause (74%) of ischemic colitis was incomplete mesenteric artery ligation.

Thus, patients without adequate treatment are at risk of descending and sigmoid ischemia. Bloody diarrhea and leukocytosis in the postoperative period essentially allow the correct diagnosis of ischemic colitis.

Video Ischemia: causes, symptoms, diagnosis, treatment and pathology

risk factors

The presence of the following factors increases the risk of developing ischemic colitis:

• Determination of fatty deposits on the walls of the artery (atherosclerosis)
• Excessively low blood pressure (hypotension), which may be due to heart failure, major surgery, trauma, or shock
• Bowel obstruction caused by a hernia, scar tissue, or tumor
• Surgical interventions that have been performed on the heart, blood vessels, digestive organs, or gynecological system
• Other medical disorders that affect circulation, such as inflammation of the blood vessels (vasculitis), systemic lupus erythematosus, or sickle cell anemia
• Use of cocaine or methamphetamine
• Colon cancer (rare)

Clinic

Three phases of development of ischemic colitis are described:

1. The hyperactive phase, which is most often manifested by severe abdominal pain and bloody stools. Many patients get better in this phase and the disease does not progress further.
2. The paralytic phase develops with ongoing ischemia. There may be abdominal pain, most often covering, the abdomen becomes more sensitive to the touch, and bowel motility decreases, leading to bloating, further bloody stools, and the absence of bowel sounds on auscultation.
3. The final phase, or shock, develops as fluid begins to seep through the damaged tissue of the colon. This can lead to shock and metabolic acidosis with dehydration, low blood pressure, tachycardia, and confusion. Such patients are often in critical condition and require intensive care.

Symptoms of ischemic colitis vary depending on the severity of ischemia. The most common early signs of ischemic colitis are abdominal pain (often left-sided), with mild to moderate loose stools.

Of the 73 patients with IC, the following frequency of occurrence of various symptoms was determined:

• abdominal pain (78%)
• bleeding (62%)
• diarrhea (38%)
• fever above 38°C (34%)

On physical examination:

• abdominal pain (77%)
• abdominal sensitivity (21%)

The risk of serious complications increases if the patient has symptoms of lesions localized on the right side of the abdomen. This is because the arteries that feed the right side of the colon also supply blood to part of the small intestine, so its supply can also be blocked. In this type of ischemic colitis, pain tends to be more severe and has a poor prognosis.

Blocked blood flow to the small intestine can quickly lead to death of the entire intestine (pannecrosis). In such cases, it is often carried out by removing part of the digestive tract.

When should you see a doctor?

Seek immediate medical attention when there is sudden, severe abdominal pain. Painful sensations may prevent the patient from sitting quietly or taking a comfortable body position.

You need to see a doctor when bloody diarrhea is determined. Early diagnosis and treatment can help prevent serious complications.

Diagnostics

Ischemic colitis must be differentiated from many other causes of abdominal pain and rectal bleeding (eg, infection, inflammatory bowel disease, diverticulosis, or colon cancer). It is also important to distinguish ischemic colitis, which often resolves on its own, from a more dangerous condition such as acute mesenteric ischemia of the small intestine.

There are methods to check whether enough oxygen is delivered to the colon. The first instrument, approved in the US in 2004, is based on visible light spectroscopy and is used to analyze capillary oxygen levels. Its use during the repair of an aortic aneurysm can detect a decrease in oxygen levels in the colon, which allows real-time restoration of impaired nutrition.

In some studies, the specificity of the method was 90% or higher in acute ischemia of the colon and 83% in chronic mesenteric ischemia with a sensitivity of 71% -92%. However, this device involves endoscopy.

Instrumental diagnostic methods

Usually p abdominal x-ray is prescribed initially and carried out in most cases with suspected acute abdominal diseases. Initial radiological findings may be normal in colonic ischemia, despite this the procedure is often performed to differentiate acute pathologies of the abdominal cavity.

Barium stain results are abnormal in 90% of patients with ischemic colitis.

CT scan- the only study after a simple x-ray that allows you to exclude many other causes of abdominal pain. With this, CT can help establish the diagnosis of intestinal ischemia. For symptomatic patients, an abdominal CT scan with oral contrast and laboratory analysis is performed.

Endoscopic evaluation, through colonoscopy or flexible sigmoidoscopy, is a selection procedure. It is used in cases where the diagnosis remains unclear. Ischemic colitis has a characteristic endoscopic appearance, and this diagnostic method can also clarify alternative diagnoses, such as infectious or inflammatory bowel disease.

Video Endoscopic Spectrum of Ischemic Colitis

MRI mainly used in conjunction with magnetic resonance angiography, especially in individuals with impaired renal function.

Ultrasonography is a non-invasive technique that can provide useful information, especially during the investigation of chronic mesenteric ischemia.

Angiography has a limited role in cases of ischemic colitis, however, it can be invaluable in some cases related to the definition of arteriovenous fistulas and steel syndrome.

Treatment

Except in the most severe cases, ischemic colitis is treated with supportive care.

• Intravenous infusion given to treat dehydration
• The patient must adhere to a strict diet until the symptoms disappear.
• If necessary, the improvement of oxygen delivery to the ischemic intestine is optimized, for which drugs that enhance the functioning of the heart and lungs are used.
• A nasogastric tube may be inserted if there is an intestinal obstruction.
• For moderate to severe IC, antibiotics are given. Prophylactic use of antibiotics has not been proven in prospective studies.

During the treatment of ischemic colitis, drugs that promote spasm of blood vessels should be avoided. These may include migraine medications, some heart medications, and hormonal medications.

Surgical intervention may be required when determining in a patient for a long time:

• fever;
• exacerbated abdominal pain;
• high level of leukocytes;
• progressive bleeding.

In such cases, the operation usually consists of a laparotomy and bowel resection.

The chance of surgery may be higher if the patient has another medical condition, such as heart failure or low blood pressure.

Prevention

Because the cause of ischemic colitis is not always fully understood, there is no definitive way to prevent the disorder. Most people with ischemic colitis recover quickly and may never have the disease again.

To prevent recurring episodes of ischemic colitis, your doctor may recommend that you avoid any medications that can cause ischemic colitis. Testing for a clotting disorder may also be done, especially if no other cause of ischemic colitis has been found.

Forecast

Most patients with ischemic colitis make a full recovery, although the prognosis depends on the severity of bowel involvement. Patients with pre-existing peripheral vascular disease or ascending (right) colon ischemia may be at increased risk of complications or death.

Non-gangrenous ischemic colitis, which is defined in most cases, is associated with mortality in about 6% of cases. However, in a smaller number of patients who develop gangrene as a result of colonic ischemia, the mortality rate is 50-75% with surgical treatment. If surgical treatment is not carried out, then the risk of death reaches almost 100%.

Long-term complications

About 20% of patients with acute ischemic colitis may subsequently suffer from chronic ischemic colitis. Symptoms of this disease include recurrent infections, bloody diarrhea, weight loss, and chronic abdominal pain. Chronic ischemic colitis is mainly treated by surgical removal of the diseased part of the bowel.

Colon stenosis is a disease that has arisen due to the growth of scar tissue, which is formed as a result of ischemic damage. It narrows the lumen of the colon by forming strictures and worsens the patient's condition. Strictures often resolve spontaneously within 12 to 24 months. If intestinal obstruction occurs due to strictures, surgical resection is most often performed, although today more gentle methods have also begun to be practiced - endoscopic dilatation and stenting.

Video 10 Diet For Ischemic Colitis

Violation of blood circulation (ischemia) of the intestinal vessels can cause a lack of blood in certain areas of the large intestine. Subsequently, in this area, the inflammatory process of the intestinal walls begins, which leads to acute pain, impaired stool, weight loss, and sometimes even to stricture (narrowing of the intestine) in this segment. In medicine, this disease is called ischemic colitis of the intestine.

Causes

Scientists have proven that the large intestine is one of the least supplied with blood internal organs. And in case of injuries, internal imbalance, internal damage to the intestinal walls, infection, blood flow decreases to critical levels. As a result, there is a risk of ischemia. Which in turn leads to ischemic colitis of the intestine.

Also, the causes of the development of this disease include the following phenomena:

• Spasms of blood vessels due to atherosclerosis. An increase in the amount of fat on the walls of blood vessels;
• Decreased blood pressure;
• The formation of blood clots (blood clots) in the vessels;
• Dissection or damage to the aorta. As a rule, it is accompanied by anemia of internal organs and dehydration of the body;
• DIC syndrome. Large-scale blood clotting in various vessels;
• Liver transplant. The body does not accept the new organ;
• The formation of a tumor in the intestine and its obstruction;
• Sickle cell anemia. Violation of the structure of the hemoglobin protein. The protein takes on a crescent shape, resulting in an imbalance in oxygen balance. This disease is hereditary.

Varieties

There are several forms of this intestinal disease: acute and chronic colitis. When diagnosing acute ischemic colitis in the human body, the organs of the intestinal mucosa die off.

With a mild variety, cell death occurs only on the lining of the intestinal wall. In the worst case, tissue necrosis may be inside the wall (intramural infarction), or all layers of the intestine may be damaged (transmural infarction).

In the chronic form of the disease, the patient has nausea, gag reflexes after eating, constipation alternates with loose stools, constant sharp pains in the abdomen. As a rule, chronic colitis leads to intestinal stricture, there is a deformation of the intestine (its narrowing). And this favorably affects the further development of intestinal diseases, and can affect the development of intestinal gangrene and the appearance of an ulcer.

Symptoms

Typically, patients experience persistent abdominal pain. Depending on the location of the damage to the colon, the focus of pain may be in the left or right side of the abdomen. Sometimes the pain can be girdle. Pain can be in the form of short attacks of 10-15 minutes, or be permanent. Specific sensations depend on the severity of the disease, and the pain can be aching, dull, pressing or intense, cutting, sharp. Usually the patient experiences pain in the intestinal area after eating. This happens almost immediately. The pain goes away after a few hours.

Foods such as cloyingly sweet, spicy, scalding foods, and dairy products can exacerbate pain. Pain can also appear after physical exertion. For example, long walks, heavy lifting, prolonged work in an uncomfortable bent position.

Another obvious symptom is loose stools with lots of blood or purulent discharge. On the walls of the rectum appear blood traces, remnants of mucus and pus. The amount of discharge depends on the form and severity of the intestinal lesion. At the initial disease, they may not be in the feces at all, but the smell of rot will already be present. Usually, at the first symptoms, diarrhea is replaced by constipation and vice versa.

Other symptoms that characterize ischemic colitis can also include:

• nausea;
• vomiting;
• Diarrhea;
• Bloating
• Sleep disturbance;
• Rapid fatigue;
• Weakness of the whole organism as a whole;
• Excessive sweating;
• Dizziness and constant headaches.

Diagnostics

As a rule, ischemic colitis is an age-related disease. About 80% of patients with this diagnosis are older than 50 years. To determine the disease, doctors conduct a general examination, pay attention to the patient's complaints and lifestyle. Analyze what could lead to such bowel disease. For example, a patient has undergone surgery or has a tumor. The constant intake of certain drugs, alcohol, spicy foods, can cause such abnormalities.

After an external examination, laboratory tests follow:

• General blood analysis. Helps to detect signs of anemia, lack of hemoglobin and red blood cells (erythrocytes). An increase in the number of leukocytes (white blood cells) is a clear sign of inflammation.
• Analysis of urine. Aimed at detecting kidney failure and infection of the internal organs.
• Fecal analysis. When detecting blood, mucous deposits, purulent discharge, one can accurately state a violation of the digestive system.
• Blood chemistry. A blood test for cholesterol and its fractions, checking the level of lipid ratio, protein and iron content in the blood, determining blood clotting indicators.

But the most effective method in determining ischemic colitis is an instrumental study. These include:

1. Colonoscopy. One of the most effective methods. As a rule, it is carried out in combination with a biopsy. The patient's large intestine is viewed using a special device - an endoscope. This procedure allows you to see the inside of the intestinal wall and assess their condition. During a biopsy, a small piece of the intestine is additionally taken for subsequent more detailed analysis and an accurate diagnosis.
2. Irrigoscopy. Examination of the intestine using x-rays. This method allows you to accurately determine the degree of damage to the intestine. And also to detect strictures and affected areas.
3. Research using ultrasound. Ultrasound of the abdominal aorta is used to identify affected cells and vessels. Thus, it is possible to detect the formation of fatty deposits on the walls of blood vessels.
4. Doppler study. Helps to determine the condition of the arteries.
5. Laparoscopy. This method includes surgery. The patient is made several small holes in the abdominal cavity. This is necessary to introduce an endoscope - a device for examining internal organs. After examining and assessing the damage, an operating instrument can be inserted through these holes and treated.
6. Electrocardiography. With the help of an ECG, fluctuations in electric fields are recorded, which makes it possible to identify deviations in the work of the intestines.

Treatment

In the initial stages of the disease, treatment mainly consists of eating certain foods and following a strict diet. It depends on the symptoms of the disease. For constipation, the patient is advised to eat foods high in fiber. Light laxatives are prescribed. With loose stools, antidiarrheals are used. Animal fats are replaced with vegetable fats. There is a tendency to reduce and completely abandon spicy, fatty and fried foods. To raise immunity and normalize the functioning of the body as a whole, vitamin complexes are prescribed.

If these methods do not help, doctors conduct antiplatelet therapy aimed at reducing blood viscosity. Prescribed vasodilators, enzymes, phospholipids. These drugs are aimed at normalizing the water-alkaline balance and bowel function in general. In some cases, a blood transfusion may be needed.

Surgical treatment is considered in severe cases, when the diagnosis is made too late and drugs are not able to cope with the infection. The affected area is removed, an audit is carried out and a special drainage is placed.

Consequences and complications

Unfortunately, complications after such operations are quite normal. Since the age of patients is quite advanced, the body is not able to immediately rebuild and normalize all its basic processes. After surgery, the patient may experience intestinal obstruction. Food either passes through the intestines too slowly, difficultly, or does not pass at all, causing flatulence, bloating, nausea and vomiting reflexes.

Sometimes a rupture of the intestinal wall can occur, leading to an infection of the whole body. The negative consequences of intestinal colitis also include an increase in the size of the large intestine and profuse hemorrhage.

Prevention

For the most part, ischemic colitis occurs with complications of atherosclerosis, during postoperative recovery of internal organs, and serious heart failure. Therefore, prevention is based on effective treatment of these diseases.

Periodic examinations by a gastroenterologist, proctologist and general surgery department can prevent intestinal diseases at an early stage and get rid of them with the help of special diets and vitamins. People diagnosed with chronic ischemic colitis should change their diet completely. Add fresh fruits and vegetables, low-fat meat, cereals to your daily diet. Refuse excess oily fish and meat products, mustard, pepper, sugary foods, coffee and alcoholic beverages. With such a diet, the likelihood of necrosis and similar complications is reduced, and bowel function is normalized without surgical intervention.

It will also be useful to study the symptoms of the disease. Knowing such information is never superfluous, because it is better to always remain on your guard. The sooner the progression of the disease is revealed, the easier and faster the treatment will be.

is an acute or chronic inflammatory disease of the large intestine, which occurs as a result of a violation of the blood supply to its walls. It is manifested by pains in the abdomen of varying intensity, unstable stools, bleeding, flatulence, nausea, vomiting and weight loss (in chronic course). In severe cases, body temperature rises, symptoms of general intoxication appear. For the purpose of diagnosis, sigmoidoscopy, irrigoscopy, colonoscopy and angiography of the inferior mesenteric artery are performed. Treatment at the initial stages is conservative, with inefficiency - surgical.

ICD-10

K55.0 K55.1

General information

Irrigoscopy is one of the most informative diagnostic studies for ischemic colitis. With reversible changes in ischemic sites, defects in the form of finger impressions can be seen. After a short time, they may disappear, so the study should be carried out immediately at the first suspicion of ischemic colitis. Necrotic changes are visible in the form of persistent ulcerative defects. When performing irrigoscopy, strictures can also be diagnosed. Colonoscopy allows you to more clearly see the morphological changes in the walls of the entire large intestine, take a biopsy from areas with ischemia or with strictures of the colon, especially if there is a suspicion of their malignant degeneration.

To determine the cause and level of vascular obstruction, angiography of the inferior mesenteric artery is performed. With complications of ischemic colitis, general and biochemical blood tests are performed to assess the patient's condition. To correct antibiotic therapy, bakposev of feces and blood is carried out with the determination of sensitivity to drugs.

Differential diagnosis for ischemic colitis is carried out with infectious diseases (dysentery, amoebiasis, helminthiases), ulcerative colitis, Crohn's disease, malignant neoplasms. In infectious diseases, symptoms of general intoxication come to the fore, there is an appropriate epidemiological history. Ulcerative colitis and Crohn's disease develop gradually at a younger age. The development of cancerous tumors of the large intestine occurs over a long period of time, often over several years.

Treatment of ischemic colitis

At the first stage of the disease, conservative therapy is carried out. A sparing diet, light laxatives, drugs that improve blood flow (vasodilating) and blood rheology (antiplatelet agents) are prescribed. Improve the results of complex treatment of ischemic colitis such drugs as dipyridamole, pentoxifylline, vitamin complexes. In a serious condition of the patient, detoxification therapy is carried out, correction of the water and electrolyte balance, and sometimes blood transfusion is performed. Of great importance for unloading the intestines is parenteral nutrition. With bacterial complications of ischemic colitis, antibiotics and sulfa drugs are prescribed.

Surgical treatment of ischemic colitis is indicated for extensive necrosis, gangrene of the large intestine, perforation and peritonitis. The affected area of ​​the intestine is removed within healthy tissues, then an audit is carried out and postoperative drainage is left. Since the age of patients with ischemic colitis is mostly elderly, complications after such operations are quite common. With strictures that block or narrow the intestinal lumen, elective surgery is performed.

Forecast and prevention

The prognosis of ischemic colitis depends on the form of the disease, the course and the presence of complications. If the blood flow resumed, and necrosis did not develop, the prognosis is quite favorable. With necrosis, everything depends on the extent of the process, timely diagnosis and correctly performed surgical intervention. Also, the course of the pathology depends on the age, general condition of the patient and concomitant diseases.

Since ischemic colitis occurs in most cases as a complication of atherosclerosis, heart failure, postoperative period during interventions on the intestines, stomach, and pelvic organs, the basis for prevention is adequate treatment of primary diseases. Proper nutrition and regular preventive medical examinations are also of great importance.