Ischemic Colitis

Posted by e-Medical PPT Thursday, April 26, 2012
Intestinal ischemia
Mesenteric ischemia - reduction in intestinal blood supply
Acute Mesenteric Ischemia
Most often involves SMA
from emboli, arterial and venous thrombi, or vasoconstriction secondary to low flow
Chronic Mesenteric Ischemia
postprandial abdominal pain, marked weight loss
 caused by repeated transient episodes of inadequate intestinal blood flow

Colonic ischemia
After aortic or cardiac bypass surgery
Certain systemic conditions
vasculitides (eg, systemic lupus erythematosis, periarteritis nodosum)
 infections (eg, cytomegalovirus, E. coli O157:H7)
coagulopathies (eg, protein C and S deficiencies, anti-thrombin III deficiency, APC resistance)
Medications (eg, oral contraceptives) or illicit drugs (eg, cocaine)
After strenuous and prolonged physical exertion (eg, long-distance running)
After any major cardiovascular episode accompanied by hypotension

Most frequent form of mesenteric ischemia 
Commonly left colon
Mostly elderly population
Low-flow state (hypotension)
Embolus (A-fib)
Post MI (hypotension, mural thrombus)
Post AAA reconstruction
Closed loop construction - left side with intact ileocecal valve
Mesenteric Vein Thrombosis
Catastrophic if not recognized

Ischemic Colitis:
Vascular Supply
Superior mesenteric artery (SMA)
Ileocolic artery – terminal ileum, cecum, appendix, prox ascending colon
Right colic artery – ascending colon, hepatic flexure
Middle colic artery – transverse colon
Inferior mesenteric artery (IMA)
Left colic artery – descending, transverse colon, splenic flexure
Sigmoid arteries – sigmoid and descending colon
Superior rectal artery – proximal rectum
Collateral flow
Marginal artery of Drummond – collateral connection between SMA and IMA along the mesenteric border
IMA and internal iliac – supply good collaterals to the rectum

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