Abstract
Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
Highlights
Ischemic colitis (IC), first described by Boley et al in the 1960s [1], is a pathological condition due to inadequate blood supply to the colon, leading to a different grade of ischemia and potentially causing significant morbidity and mortality [2]
In this article we review the pathophysiology and the imaging findings of ischemic colitis
IC is frequently related with non-occlusive etiology, but computed tomography (CT) angiography with multiplanar reconstructions along multiple planes is useful to assess the luminal patency of the celiac trunk, superior mesenteric artery (SMA), inferior mesenteric artery (IMA) and their main branches, with a high sensitivity and specificity (93.3% and 95.9%, respectively) [88]
Summary
Ischemic colitis (IC), first described by Boley et al in the 1960s [1], is a pathological condition due to inadequate blood supply to the colon, leading to a different grade of ischemia and potentially causing significant morbidity and mortality [2]. IC is the most frequent form of intestinal ischemia [3] and the second-most common cause of lower gastrointestinal bleeding after colonic diverticulosis [4]. IC is most frequently seen in elderly patients (≥65 years) and increases in incidence with increasing age [5,6,7]; it can occur in younger (≤65 years) patients [8]. IC may manifest with a mild transient form, with a nonspecific and very variable clinical presentation [10]. The majority of patients complain for diarrhea, hematochezia and crampy abdominal pain [11,12]
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