Treatment of ischemic colitis. Diagnosis and treatment of ischemic colitis Chronic ischemic colitis

Ischemic colitis is a transient disorder of blood circulation in the colon.

The blood supply to the large intestine is provided by the superior and inferior mesenteric arteries. The superior mesenteric artery supplies blood to the entire small, blind, ascending and partially transverse colon; lower mesenteric artery - the left half of the colon.

With ischemia of the large intestine, a significant number of microorganisms inhabiting it contributes to the development of inflammation in the intestinal wall (even transient bacterial invasion is possible). The inflammatory process caused by ischemia of the colon wall further leads to the development of connective tissue in it and even the formation of a fibrous stricture.

Most constantly with ischemic colitis, the splenic flexure and the left colon are affected.

What causes ischemic colitis?

Necrosis may develop, but usually the process is limited to the mucous and submucous membranes and only occasionally affects the entire wall, which requires surgical intervention. It occurs mainly in the elderly (over 60 years of age) and the etiology is unknown, although there is some association with the same risk factors for acute mesenteric ischemia.

Ischemic colitis symptoms

Symptoms of ischemic colitis are less severe and develop more slowly than with acute mesenteric ischemia, and include pain in the left lower quadrant of the abdomen, accompanied by bleeding from the rectum.

Stomach ache. Pain in the abdomen manifests itself 15-20 minutes after eating (especially plentiful) and lasts from 1 to 3 hours. The intensity of pain is different, often they are quite strong. With the progression of the disease and the development of fibrous strictures of the colon, pain becomes constant.

The most common localization of pain is the left iliac region, the projection of the splenic flexure of the transverse colon, less often the epigastric or peri-umbilical region.

Dyspeptic disorders. Almost 50% of patients experience decreased appetite, nausea, bloating, sometimes belching with air, food.
Stool disorders. They are observed almost constantly and are manifested by constipation or diarrhea, alternating with constipation. During the period of exacerbation, diarrhea is more characteristic.
Weight loss patients. The drop in body weight in patients with ischemic colitis is observed quite naturally. This is due to the limited amount of food and the frequency of its intake (due to increased pain after eating) and impaired intestinal absorption function (quite often, along with ischemia of the large intestine, there is a deterioration in blood circulation in the small intestine).
Intestinal bleeding. Observed in 80% of patients. The intensity of bleeding is different - from the admixture of blood in the stool to the release of significant amounts of blood from the rectum. Bleeding is caused by erosive and ulcerative changes in the mucous membrane of the colon.
Objective abdominal syndrome. Exacerbation of ischemic colitis is characterized by mild signs of irritation of the peritoneum, tension of the abdominal muscles. On palpation of the abdomen, diffuse sensitivity is noted, as well as soreness, mainly in the left iliac region or the left half of the abdomen.

Symptoms of severe irritation of the peritoneum, especially lasting several hours, make one think about transmural necrosis of the intestine.

Diagnosis of ischemic colitis

Diagnosis is by colonoscopy; angiography is not indicated.

Laboratory and instrumental data

General blood test: characterized by pronounced leukocytosis, a shift of the leukocyte formula to the left, an increase in ESR. With repeated intestinal bleeding, anemia develops.
Urinalysis: no significant changes.
Stool analysis: a large number of erythrocytes, leukocytes, and intestinal epithelial cells are found in the stool.
Biochemical blood test: a decrease in the content of total protein, albumin (with a long course of the disease), iron, sometimes sodium, potassium, calcium.

Colonoscopy: carried out strictly according to indications and only after reducing acute manifestations. The following changes are revealed: nodular areas of the edematous mucous membrane of a blue-purple color, hemorrhagic lesions of the mucous membrane and submucosa, ulcerative defects (in the form of dots, longitudinal, serpentine), strictures are often found, mainly in the area of the splenic flexure of the transverse colon.

Microscopic examination of colon biopsies reveals edema and thickening, fibrosis of the submucosal layer, its infiltration with lymphocytes, plasma cells, granulation tissue in the area of the bottom of ulcers. A characteristic microscopic sign of ischemic colitis is the presence of multiple hemosiderin-containing macrophages.

Plain X-ray of the abdominal cavity: an increased amount of air in the splenic corner of the colon or other parts of it is determined.
Irrigoscopy: performed only after the relief of acute manifestations of the disease. At the level of the lesion, the narrowing of the colon is determined, above and below - the expansion of the intestine; the haustra are poorly expressed; sometimes visible nodular, polypid thickening of the mucous membrane, ulceration. In the marginal areas of the intestine, fingerprints (a symptom of a "thumbprint") are detected, caused by swelling of the mucous membrane; serration and unevenness of the mucous membrane.
Angiography and Doppler ultrasonography: a decrease in the lumen of the mesenteric arteries is detected.
Parietal colon pH measurement using a balloon catheter: Compares tissue pH before and after meals. Intramural acidosis is a sign of tissue ischemia.

The following circumstances help in the diagnosis of ischemic colitis:

age over 60-65 years old;
the presence of coronary artery disease, arterial hypertension, diabetes mellitus, obliterating atherosclerosis of the peripheral arteries (these diseases significantly increase the risk of ischemic colitis);
episodes of acute abdominal pain followed by intestinal bleeding;
the corresponding endoscopic picture of the state of the colon mucosa and the results of histological examination of colon biopsies;

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. Manifested by abdominal pain of varying intensity, unstable stool, bleeding, flatulence, nausea, vomiting and weight loss (in chronic course). In severe cases, the 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 ineffectiveness - surgical.

ICD-10

K55.0 K55.1

General information

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

To find out the cause and level of vascular obstruction, angiography of the inferior mesenteric artery is performed. In case of complications of ischemic colitis, general and biochemical blood tests are performed to assess the patient's condition. For the correction of antibiotic therapy, a bacterial culture of feces and blood is carried out with the determination of sensitivity to drugs.

Differential diagnosis in ischemic colitis is carried out with infectious diseases (dysentery, amebiasis, helminthiasis), ulcerative colitis, Crohn's disease, malignant neoplasms. In infectious diseases, the symptoms of general intoxication come to the fore, there is a corresponding epidemiological history. Ulcerative colitis and Crohn's disease develop gradually at a younger age. Colon cancers develop 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. Prescribe a sparing diet, mild laxatives, drugs that improve blood flow (vasodilators) and blood rheology (antiplatelet agents). Such drugs as dipyridamole, pentoxifylline, vitamin complexes improve the results of complex treatment of ischemic colitis. In a serious condition of the patient, detoxification therapy, correction of the water-electrolyte balance is carried out, sometimes blood transfusion is performed. Parenteral nutrition is of great importance for unloading the intestines. For bacterial complications of ischemic colitis, antibiotics and sulfa drugs are prescribed.

Surgical treatment of ischemic colitis is indicated for extensive necrosis, colon gangrene, perforation, and peritonitis. The affected area of the intestine is removed within healthy tissues, then a revision is performed and postoperative drainage is left. Since the age of patients with ischemic colitis is mostly elderly, complications after such operations are quite common. For 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 blood flow has resumed and necrosis has not developed, the prognosis is good. With necrosis, everything depends on the vastness 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, the postoperative period during interventions on the intestines, stomach, pelvic organs, the basis of prevention is adequate treatment of primary diseases. Proper nutrition and regular preventive medical examinations are also of great importance.

The development of ischemic disease of the colon with thrombosis and embolism, vascular injury, allergic reactions is associated with vascular occlusion and, as a rule, is accompanied by the development of gangrene, although the transition to a chronic form with the gradual formation of a stricture or a prolonged course of ulcerative colitis is not excluded. The development of one or another form of the disease in this situation is due to the state of collateral circulation, the diameter of the damaged vessel, the completeness and duration of the occlusion, the rate of revascularization, etc.

Along with this, there are non-occlusive lesions, the possibility of which is associated with the anatomical and functional features of the colon. In addition to the fact that the blood flow in the large intestine is the lowest in comparison with other organs, there are also the most vulnerable places - anastomoses between the branches of the great vessels of the large intestine. It should also be borne in mind that the functional activity of this organ is normally accompanied by a decrease in blood flow in it. In this regard, it becomes clear that any pathological processes accompanied by hypovolemia, such as chronic heart disease with congestive heart failure, abdominal aortic aneurysms, shock, strokes, massive bleeding occurring with hypotension syndrome, are important predisposing factors in the development of chronic forms ischemic colon disease.

Restriction of blood flow due to atherosclerosis of the aorta and colon arteries can lead to ischemia, especially in the left bend and proximal part of the sigmoid colon. Therefore, chronic forms of ischemic colitis are more often manifested by segmental lesions.

Violations of the mesenteric blood supply under the action of such vasopressor agents as ephedrine, adrenaline, vasopressin, estrogen-containing contraceptives are described.

In ischemic colitis, the mucous membrane is primarily affected, since it is especially sensitive to states of hypoxia. Apparently, this is due to the high activity of the metabolic processes occurring in it.

In mild and moderate forms of ischemic colitis, not only the serous and muscular membranes remain viable, but also changes in the mucous membrane, if they do not represent necrosis, can almost completely reverse development. Only in severe forms does deep damage occur, often resulting in perforation or the formation of strictures.

Clinic and diagnostics

The clinical picture of ischemic colitis is not particularly specific and is characterized by pain syndrome, repeated intestinal bleeding and unstable stools with pathological impurities. The severity of certain symptoms is largely determined by the nature of the course and the form of the disease.

Along the course, ischemic colitis can be acute or chronic, and depending on the degree of impaired blood supply and tissue damage, two forms are distinguished - reversible (transient ischemia) and irreversible with the formation of either stricture or gangrene of the intestinal wall.

Reversible (transitory) form. With this form of the disease, pathological changes in the colon are observed only for a short time and quickly undergo a complete reverse development. The main symptom of the disease is pain in the left side of the abdomen, which occurs suddenly and just as quickly disappears spontaneously. The attacks of pain can be repeated during the day, and the intensity is different. More often it is not pronounced or so insignificant that patients forget about it and only with careful questioning it is possible to identify it. It sometimes resembles coronary pain or pain with intermittent claudication and is associated with intestinal functional activity caused by digestive processes. The fact that pain often occurs 15-20 minutes after a meal, subsides after a few hours and is localized along the colon, has an important diagnostic value, indicating a possible ischemic nature. The pain is often accompanied by tenesmus and blood in the stool. In some cases, bleeding occurs several days or even weeks after the onset of the disease. The blood is mixed and can be dark or bright red. Its amount, as a rule, is insignificant, and massive bleeding usually testifies against ischemic lesions of the intestine. Along with the admixture of blood, ischemic colitis is characterized by frequent secretion of mucus from the anus, especially after a painful attack.

Fever, tachycardia, leukocytosis are signs of the progression of ischemic colitis.

Palpation of the abdomen determines moderate pain along the colon. Signs of peritoneal irritation may also be found. At the same time, an increase in peritoneal phenomena indicates the onset of irreversible ischemic changes in the colon.

Sigmoidoscopy in an acute episode of ischemia only in rare cases reveals typical submucosal hemorrhages; rectal biopsy has a certain diagnostic value, in which changes characteristic of ischemia are determined.

Colonoscopy reveals submucosal hemorrhages and an erosive process against the background of unchanged or pale (a consequence of a blood supply disorder) mucous membrane. The changes are focal in nature and are most pronounced at the tops of the haustra.

X-ray examination of the colon with barium enema is of great importance in the diagnosis of reversible ischemic disease of the colon. An important radiological sign of ischemic colitis is the symptom of the so-called "digital impressions". It represents oval or rounded filling defects, which are projected by submucous hemorrhages in the intestinal wall. However, a reliable sign of vascular lesions is their appearance only when the colon is tightly filled with barium. Hemorrhages usually resolve within a few days, and the “digital depressions” symptom disappears. With a more pronounced degree of ischemia, the mucous membrane over the site of hemorrhage is rejected, forming an ulcerative defect.

Delaying the implementation of these research methods, especially irrigoscopy, can interfere with establishing the correct diagnosis, since lesions with a reversible form often disappear without treatment.

There are two possible outcomes of reversible (transient) ischemic colitis - resolution or progression of the process with the transition to an irreversible form with the development of ischemic stricture.

With the further development of ischemic colitis, ulcers form at the site of mucosal defects and an admixture of pus appears in the feces. In connection with exudation into the lumen of the intestine, the feces become liquid. With a digital examination of the rectum, there may be dark blood and pus in its lumen. In such cases, sigmoidoscopy can reveal ulcerative defects of irregular shape with a sharp border, covered with fibrinous plaque. These changes are visible against the background of unchanged or pale mucous membranes.

With irrigoscopy, there is a significant variability in the areas of lesion of the colon - from short to long sections. In the altered segments, the phenomena of spasm, irritability, loss of haustration, smooth or uneven, jagged contour of the intestine are determined. Spasm and edema are much more pronounced than with transient ischemia. With a sharp spasm localized in a short segment, radiographic changes are similar to a tumor process. If there is persistent narrowing, which is detected during repeated examinations, colonoscopy or laparotomy is indicated to exclude a diagnostic error.

Colonoscopy reveals an erosive and ulcerative process, localized most often in the left half of the large intestine, especially in its proximal part. Ulcers have various shapes, often twisted and covered with a grayish purulent film. In more severe lesions, necrosis and mucosal rejection are determined. In this case, the inner surface of the intestine is represented by extensive ulcerative defects with clear boundaries.

An irreversible form of ischemic colitis. This form is more common in middle-aged and elderly people with heart disease or atherosclerosis and is diagnosed in the absence of a history of chronic bowel disorders. Its most characteristic manifestation is the formation of a colon stricture.

In the clinical picture during the formation of a stricture, symptoms of increasing intestinal obstruction dominate: cramping pain, pronounced rumbling and periodic bloating, alternating constipation and diarrhea.

Radiological manifestations of the irreversible form along with the symptom of "digital depressions" are irregularity of the contours of the mucous membrane due to the subsiding of edema and the appearance of ulcers, tubular narrowing and saccular protrusions on the opposite mesentery wall of the intestine, which can be mistaken for diverticula. Ischemic stricture rarely takes the form of a neoplastic lesion with well-defined boundaries, but if there is persistent narrowing of the colon, it is necessary to exclude malignant disease.

Colonoscopy reveals a narrowing of the intestinal lumen, usually of irregular shape, with cicatricial bridges, the mucous membrane to the stricture is usually unchanged or with minor inflammatory manifestations, which distinguishes it from the stricture in Crohn's disease.

Histological changes are often limited only to the mucous membrane, but can cover the entire thickness of the intestinal wall. Along with typical hemorrhages, there are phenomena of membranous and pseudomembranous colitis, in which pathological areas are located in the form of spots. The most characteristic microscopic sign of ischemic colitis, in addition to hemorrhage and ulceration, is the presence of many hemosiderin-containing macrophages.

The angiography of the inferior mesenteric artery has the greatest diagnostic value, although according to indications it is possible to conduct a study of blood flow in the right sections of the colon by catheterization of the superior mesenteric artery. Angiographic examination of intestinal vessels is performed according to the generally accepted technique.

Differential diagnosis

The differential diagnosis of ischemic colitis is with ulcerative colitis, Crohn's disease, cancer, diverticulitis, and intestinal obstruction.

The vascular nature of the disease should be primarily suspected in elderly people suffering from cardiovascular diseases, with manifestations of atypical ulcerative colitis and a short history. In cases where an elderly patient complains of intestinal bleeding, which appeared soon after a collaptoid state, hypertensive crisis, etc., the diagnosis of ischemic colitis does not present any particular difficulties. It should be considered that ulcerative colitis almost invariably proceeds with the defeat of the rectum and in the active stage of the process, rectal biopsy reveals characteristic changes.

Ischemic colitis differs from Crohn's disease by the constant localization of the process in the splenic flexure and the absence of anal and perianal lesions. The data of histological examination with the detection of typical granulomas also help.

Differential diagnosis of ischemic colon disease, ulcerative colitis and Crohn's disease is given in the table.

Sign	Ischemic fatty disease intestines	Ulcerative colitis	Crohn's disease
Start	spicy	often gradual	gradual
Age 50 and older	80%	less than 10%	less than 5%
Rectal bleeding	single	regular	uncharacteristic
Formation of strictures	characteristically	uncharacteristic	characteristically
Concomitant diseases of the cardiovascular system	are characteristic	rare	rare
The course of the disease	rapidly changing	chronic, less often acute	Chronic
Segmented lesion	characteristic	uncharacteristic	characteristic
Characteristic localization	splenic flexure, descending, sigmoid, transverse colon	rectum, in some cases lesion of more proximal segments of the colon	terminal ileitis, right half of the colon, total colitis
"Finger indentations" on radiographs	are characteristic	very rare	uncharacteristic
Histological picture	macrophages containing hemosiderin	crypt abscesses	sarcoid granulomas

Treatment

Correct treatment of the reversible form of ischemic colon disease requires early diagnosis and continuous monitoring of the patient with careful repeated X-ray control. Therapy of reversible ischemia consists in the appointment of a diet, mild laxatives, vasodilators and antiplatelet agents. In the future, for prophylactic purposes, patients are recommended to take prodectin 0.6 g 4 times a day, trental 0.48 g 3 times a day, courantil 200-400 mg / day to improve the rheological properties as an antiplatelet agent or other drugs that improve blood circulation. In some cases, this can be facilitated by the appointment of gammalon 25-50 mg 3 times a day in combination with stugerone 0.25 mg 3 times a day.

Vitamin therapy is of great importance: ascorbic acid, askorutin, B vitamins, multivitamin preparations (undevit, gendevit, ferroplex), etc.

With a more pronounced clinic, not accompanied by shock and a picture of peritonitis, transfusion therapy is added to the treatment, aimed at correcting the water-electrolyte balance, blood transfusion, and parenteral nutrition. It should be noted that parenteral nutrition creates physiological rest in the colon and is therefore an important point of treatment. Analgesics should be prescribed with caution so as not to miss the possible development of peritonitis due to the progression of the disease. In the case of a secondary infection, it is necessary to use antibiotics and sulfonamides, taking into account the sensitivity of the flora.

When the colon is dilated, it is decompression performed using a colonoscope, a gas outlet tube. Corticosteroids, in contrast to ulcerative colitis and Crohn's disease, for which they are effective, are contraindicated in ischemic colon disease.

In the complex treatment of ischemic disease of the colon, a special place is occupied by hyperbaric oxygenation, since it allows a dosed increase in the degree of oxygen perfusion due to physically dissolved oxygen and thereby correct tissue hypoxia. The experience of using hyperbaric oxygenation in the treatment of ischemic colitis shows that after 2-4 sessions, patients notice an improvement in sleep and mood, a surge of vivacity. In a relatively short time, the pain syndrome is eliminated, the reparative processes in the colon are accelerated. Hyperbaric oxygenation potentiates the action of anti-inflammatory drugs.

Usually, 1 course of treatment of 10-15 sessions is sufficient, carried out daily with a 40-60-minute exposure at an optimal level of oxygen compression, individually selected titration, that is, by gradual, from session to session, increasing the oxygen pressure in the interval 1.3- 2 atm. under the control of blood pressure, heart rate, acid-base state, clinical, electrocardiographic and rheo-encephalographic data.

Long-term results indicate the preservation of a positive clinical effect for 3-5 months, after which it is advisable to repeat the course of hyperbaric oxygenation.

It should be emphasized that if ischemic damage lasts 7-10 days, despite treatment, or if symptoms increase, surgical treatment should be used.

After the symptoms of ischemic colon disease have subsided, a double X-ray examination with a barium enema is performed within a year, which facilitates the diagnosis of emerging strictures or shows the reverse development of changes in the colon.

In the presence of a stricture, indications for surgery are signs of intestinal obstruction or suspicion of malignant degeneration in the narrowing zone. It is better to perform the operation in a planned manner, which creates the conditions for resection of the large intestine with the simultaneous restoration of its patency.

With the gangrenous form of ischemic disease of the colon, the only treatment is an emergency operation, which consists in resection of the necrotic colon according to Mikulich or Hartmann. Simultaneous restoration of colon patency is undesirable, since it is very difficult to determine the true prevalence of ischemic lesions. Erroneous determination of the boundaries of the resection leads to repeated surgical interventions due to continuing necrosis and dehiscence of the anastomotic sutures. It is quite understandable, given the elderly age of patients, the importance of careful preoperative preparation and postoperative care, as well as the prevention of hypovolemia, sepsis, and renal dysfunction.

Forecast in ischemic disease of the colon, in cases of adequate therapeutic or surgical treatment, it is favorable.

Caused by inadequate blood supply, is the most common manifestation of intestinal ischemia (60%). The severity depends on the localization 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 sections of the colon. Many different etiological factors lead to general pathological changes:

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

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

Attention: patients may have other significant pathological changes (for example, cancer) in the affected or unaffected parts.

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

a) Epidemiology of ischemic colitis:
The peak incidence is observed between 60 and 90 years of age. Women are affected more often than men. Reason for urgent hospitalization in one case in 2000.
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,

b) Ischemic colitis symptoms

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 pain relief, bleeding (unchanged blood in the stool), mild peritoneal symptoms.
The 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 wall changes => perforation, sepsis, oliguria, multiple organ failure, death.
- Sepsis -> bacterial colonization of implants placed due to ischemia (e.g. artificial valves, aortic prostheses, etc.)

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

v) Differential diagnosis of ischemic colitis:
- IBD: ulcerative colitis,.
- Infectious colitis: Shigella, enterohaemorrhagic 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.

a, b - Pneumatosis of the colon and gas in the portal veins in a patient with ischemic colitis. Pneumatosis of the intestine (a) is manifested by a curved contour of gas (shown by arrows) along the contour of the fluid-filled lumen of the colon.
On the periphery of the left lobe of the liver (b), many tubes filled with gas are seen (ps arrows). CT scan.
c - Symmetrical thickening (arrow) of the lower part of the descending colon (barely noticeable thickening of the wall) corresponds to the area shown by the white arrow on the roentgenogram.
Computed tomography through the superior aperture of the pelvis.
d - Ischemic colitis in a patient with pain in the left lower quadrant of the abdomen.
A thickening of the wall of the descending colon (indicated by an arrow) with a dissection in the region of the wall was found. CT scan.

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

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

a - Macroscopic picture of severe acute ischemic colitis with total infarction of the intestinal wall.
b - Macroscopic picture of the colon with ischemic colitis. Areas of necrosis, peritonitis are visible.
c - Onset of ischemic colitis. Thickening of the submucosal layer due to edema (on a radiopaque image with barium, the picture of a "thumbprint"), hemorrhagic necrosis of the mucous membrane are noticeable.
The muscularis mucosa is still viable. Total microscopic section of the intestinal wall.
d - Secondary ischemia with mesenteric vein thrombosis.
Microscopic picture: a characteristic massive accumulation of blood in the intestinal wall with necrosis of the mucous membrane and the muscle layer of the lamina propria and thrombosis of the veins of the submucous layer is visible.
e - Ischemic colitis with atheromatous embolism.
Microscopic picture: massive edema of the submucosal layer, hemorrhages and foci of necrosis of the mucous membrane, a large cholesterol embolus in the lumen of the muscular artery deep in the submucosal layer (main center) were found.

e) Examination for ischemic colitis

Required minimum standard:
Anamnesis:
- Recently undergone vascular surgery, embolism, "abdominal toad", history of vasculitis, medication (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), stability of hemodynamic parameters?
- Abdominal distension, abdominal pain inappropriate to clinical findings, hyperperistalsis or paresis, peritoneal symptoms?
- Preservation of the pulse on the femoral arteries and distal vessels of the extremities? Signs of advanced atherosclerosis?

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

Radiation imaging techniques:
- Radiography of the abdominal cavity / chest organs: free gas, “digital depressions” symptom, loss of haustration, widening of loops.
- CT with oral / intravenous contrast, if possible (renal function!): Most practical if pain is the primary symptom => free gas in the abdominal cavity, segmental thickening of the bowel wall, digital sign, pneumatosis, loss of haustration, enlargement loops, double nimbus symptom, gas in the portal vein? Other causes of abdominal pain? The state of the main pathways 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 mucous membrane => hemorrhages, necrosis, ulcers, vulnerability? Strictures?

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

a - Ischemic colitis with pneumatosis of the colon. Tiny vesicles are visible overlying the shadow of the colon. Air bubbles in the intestinal wall, side view (shown by arrows).
The intestinal lumen is crossed by a thick fold (shown by the white arrow). X-ray of the descending colon.
b - A picture of a "thumbprint" on a single photograph of a patient with acute ischemic colitis. Barium contrast enema.
c - Ischemic colitis with pneumatosis of the colon. A curved strip of air (shown by arrows) is located around the contrast-filled intestinal lumen.
Computed tomography at the level of the descending colon.

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%).

g) Treatment without surgery for ischemic colitis:
Restoration of hemodynamic parameters: volume replenishment is more important than the use of vasopressors.
Broad spectrum antibiotics, clinical trial series with colon "rest" periods.
Heparinization, if tolerated.
Possibly interventional radiology.
Repeated colonoscopy: monitoring the effectiveness of treatment, reexamining the colon under optimal conditions to detect other pathological changes.

a - area of acute focal ischemia. Colonoscopy.
b - ischemic colitis of the splenic flexure.
Almost pathognomonic internal bleeding. Colonoscopy.

h) Surgery for ischemic colitis:

Indications:
Acute ischemia: peritonitis, pain inappropriate to clinical examination data, signs of gangrene, refractory sepsis, pneumoperitoneum; no improvement, persistent protein loss due to bowel pathological changes (lasting> 14 days).
Chronic ischemia: recurrent sepsis, symptomatic colon stricture, any stricture in which a tumor is possible.

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, palpable pulse?
- Primary anastomosis or stoma (eg double-barreled).
- Controversial viability: planned relaparotomy or more extended resection.
Explorative laparotomy, if the area of necrosis is too large and incomparable 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 ischemic colitis treatment:
Transient ischemia: relatively good prognosis, largely dependent on prognosis for 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 long (up to 6 months) => stricture?
Gangrenous ischemia: mortality in 50-60% of cases - the population of patients with concomitant diseases and with the most severe course of the disease!
Chronic ischemia: The complication rate and mortality are the same as for resection of the colon for other diseases, but the risk of cardiovascular complications is higher.

To) Follow-up and further treatment:
A complete 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 complete restoration of physical condition and nutrition.
Determination of the variant and duration of anticoagulant therapy.

Is an inflammatory process in the large intestine that occurs with a transient violation of the blood supply to its wall. Usually develops after the age of 60 years. The diagnosis is confirmed by computed tomography, irrigoscopy and colonoscopy. It is treated mainly conservatively. Surgical intervention is indicated with a significant spread of the process and necrosis of a large section of the intestinal wall.

Options for the course of the disease:

Acute colitis. Arises suddenly against the background of complete well-being. It is accompanied by vivid clinical symptoms, rapid deterioration of the condition.
Chronic colitis. Symptoms are moderate or subtle. The patient's condition worsens gradually.

Gastrointestinal symptoms

Local symptoms come to the fore in chronic colitis:

The intensity of the symptoms depends on the extent of the process. If the pathological focus is limited to a small segment of the intestine, the manifestations of the disease will be weak, erased. With a significant violation of blood circulation, the signs of colitis increase.

The manifestations of the disease also depend on the stage of its development:

With a reversible violation of blood flow in the intestine, pain occurs periodically and almost always subside on its own. Blood in the stool and bleeding occurs several days after the onset of the disease. Reversible ischemic colitis is possible with a short-term disturbance of blood flow or against the background of the development of collaterals (bypass blood vessels).
With an irreversible violation of the blood supply, the symptoms progressively increase. The pain intensifies, the stool becomes liquid with an admixture of blood. The general condition is deteriorating, signs of intoxication of the body appear. This option is possible with significant impairment of blood flow, intestinal necrosis and the absence of collaterals.

Extraintestinal (general) symptoms

A change in the general condition is characteristic of acute colitis with irreversible impairment of blood flow. The following symptoms appear:

Signs of general intoxication increase along with an increase in the area of necrosis (tissue necrosis) of the intestine.

In chronic ischemic colitis, other symptoms may appear:

general weakness, weakness;
decreased performance, memory impairment;
anemia - a decrease in hemoglobin and red blood cells in the blood, leading to oxygen starvation of tissues;
signs of a lack of certain vitamins in violation of their absorption (dry skin, brittle nails and hair, muscle weakness, muscle cramps, etc.).

The reasons for the development of the disease

The main cause of ischemic colitis is a decrease in blood flow in a specific area of the colon. The following conditions can cause ischemia:

Options for the course of the disease:

Occlusive ischemia. With complete overlap (occlusion) of the lumen of the vessel, acute ischemic colitis develops. The area of the colon lesion will depend on the diameter of the vessel and the duration of the occlusion, the possibility of developing collateral blood flow. With incomplete overlap, chronic colitis is formed.
Non-occlusive ischemia. It occurs with a decrease in blood pressure in the vessels that feed the intestines. Usually a chronic form of pathology develops.

Diagnostics

Differential diagnosis is carried out with the following conditions:

The final diagnosis is made after colonoscopy with biopsy, irrigography, computed tomography.

Treatment principles

Therapy for ischemic colitis begins with diet and medication. The operation is rarely performed and is indicated only in the presence of conditions that threaten the patient's life.

Diet

General principles of nutrition for ischemic colitis:

Frequent and fractional meals. 5-6 smaller meals are recommended. Dinner should be 2-3 hours before bedtime.
Steam cooking, boiled. Fried foods are not recommended until complete recovery or stable remission.
Drinking regime. You need to drink up to 1.5-2 liters of clean water per day, if there are no contraindications (severe heart and kidney diseases).

The list of products is presented in the table.

Featured Products	Products not recommended
low-fat varieties of poultry, fish, meat; rye flour bread; uncooked pastries (in moderation); cereals (oatmeal, buckwheat, millet); vegetable broth soups; low-fat dairy products; hard cheese; vegetables (except prohibited ones); greens; non-acidic fruits and berries; homemade jam, honey	fatty meats, fish, poultry; White bread; rich pastries; semolina; soups with meat and fish broth; fermented milk products with a high fat content; processed cheese; vegetables that cause gas (cabbage, legumes); sour berries and fruits; condiments and sauces; smoked products, sausages, canned food; confectionery; milk chocolate; tea, coffee, cocoa; alcohol

With a common process, the patient is transferred to parenteral nutrition.

Drug therapy

Depending on the specific clinical situation, the following drugs are prescribed:

Surgical therapy

Indications for surgery:

Intestinal resection is performed - excision of a part of the organ affected by necrosis. The scope of the operation depends on the extent of the process. The ends of the intestinal tube are matched and sutured. An abdominal revision is performed - pus is removed. With extensive lesions, when it is not possible to match the ends of the intestine, a stoma is formed - an opening on the front wall of the abdomen for the removal of feces.

Complications and prognosis for life

Without treatment, ischemic colitis leads to the development of complications:

With the development of complications, surgical treatment is indicated.

The prognosis is favorable with the timely diagnosis of pathology. After the prescribed therapy, you can achieve a stable remission of the disease. Relapse occurs in 5% of cases. In advanced situations, the development of peritonitis and sepsis, a lethal outcome is possible.

Prophylaxis

Since it is not always possible to find out the exact cause of ischemic colitis, it is difficult to talk about its prevention. You can reduce the risk of developing the disease if you follow the recommendations:

give up bad habits: smoking, drinking alcohol;
timely treat diseases of the large intestine, cardiovascular system;
monitor weight, blood pressure, blood cholesterol levels.

When the first signs of the disease appear, you need to consult a doctor - a therapist, gastroenterologist, surgeon. It is important to remember that pain and bleeding occur in various pathologies, and only after examination can an accurate diagnosis be made. Delay is dangerous to health and life.

Ischemic colitis is an inflammatory disease that affects the large intestine and is formed due to segmental circulatory disorders.

The main reason for the appearance of such a disorder is spasm or occlusion of the blood vessels supplying this organ. A large number of diseases and predisposing factors can become sources of such disorders.

The disease has no specific clinical manifestations, which makes the diagnosis much more difficult. The main symptoms include pain syndrome, increased gas production, nausea and belching. Establishing the correct diagnosis involves the implementation of a number of laboratory and instrumental diagnostic measures.

Treatment can be both conservative and surgical. The basis of therapy is adherence to a sparing diet, the appointment of medications and excision of the affected part of the intestine.

Etiology

The large intestine is one of the group of those internal organs that are rather poorly supplied with blood, and its functional activity leads to an even greater decrease in blood flow. It is for this reason that a wide range of pathologies can lead to the development of ischemia and ischemic colitis.

The fundamental sources of such a disease can be considered:

heart failure;
atherosclerotic lesion of the blood vessels - with such a disorder, lipids accumulate in the walls of the vessels;
the formation of blood clots;
DIC syndrome, which is characterized by a violation of the blood coagulation process;
hypoperfusion or insufficient blood supply to this organ;
the course of the inflammatory process in the vessels of the large intestine;
aortic dissection;
such a hereditary pathology as sickle cell anemia;
intestinal obstruction;
transplantation of a donor organ, namely a liver;
malignant or benign tumors in the intestine;
severe blood loss from trauma or surgery;
loss of a large amount of fluid against the background of infectious processes in the intestine;
systemic vasculitis;
allergic reactions.

Often, ischemic colitis affects the sigmoid or transverse colon, especially when atherosclerosis is a factor in the onset of the disease. However, this does not mean at all that the defeat of other parts of this organ is completely excluded.

Classification

By the nature of the course, the disease is divided into:

acute ischemic colitis - is characterized by the rapid development of symptoms and a significant deterioration in a person's condition. It is accompanied by an infarction of the mucous or submucous layer, as well as the entire intestine;
chronic ischemic colitis - characterized by an undulating course and over time can be complicated by the formation of strictures.

In addition, there are several more forms of the course of the disease:

transient - expressed in a periodic violation of blood circulation in the vessels of this organ. Against this background, the development of the inflammatory process occurs, which is then independently neutralized;
stenosing or pseudotumorous - scarring occurs due to constant inflammation and circulatory disorders. This leads to a narrowing of the affected organ;
gangrenous - is considered the most severe type of ailment, since all layers of the large intestine are involved in the disease-causing process. In almost all cases, this form leads to the development of complications.

Separately, it is worth highlighting idiopathic ischemic colitis, the causes of which could not be clarified.

Symptoms

The manifestation of clinical signs of such an ailment directly depends on the degree of circulatory disturbance in the affected organ - the larger the area is affected, the more vivid the symptoms will be. Thus, the symptoms of ischemic colitis will be as follows:

pain syndrome. The place of its localization will correspond to the place of intestinal lesion. Pain can occur in the left or right side of the abdomen, and is often shingles in nature. There is a spread of pain in the lumbar region, shoulder blades, neck and back of the head;
an increase in the size of the abdomen;
increased gas production and sweating;
violation of the stool, which is expressed in the alternation of constipation and diarrhea. The feces contain impurities of blood and mucus;
a decrease in body weight, which occurs against the background of refusal to eat, which, in turn, is caused by the appearance of signs after eating food;
sleep disturbance - there is drowsiness during the day and a complete lack of sleep at night;
weakness of the body and rapid fatigue, which reduces the performance of a person;
attacks of severe headache;
an increase in body temperature indicators;
pallor of the skin;
the formation of xanthelasmas and xanthomas - they are often located on the chest, elbows and back;
intestinal bleeding.

If the above clinical manifestations begin to pass on their own, after which they increase sharply, then this indicates that the disease has become irreversible.

Diagnostics

The instrumental methods of examining the patient have the greatest diagnostic value, however, before prescribing them, the clinician must independently perform several manipulations:

conduct a detailed survey of the patient regarding the severity of the manifestation of symptoms;
familiarize yourself with the patient's medical history and life history - to identify what etiological factors preceded the development of the disease;
perform a thorough physical examination, which includes measuring blood pressure and temperature, as well as palpation of the anterior wall of the peritoneum.

Laboratory research is aimed at performing:

clinical blood test;
samples for studying blood clotting;
serum lipid spectrum;
general urine examination;
microscopic examination of feces - it is possible to detect impurities of blood and mucus.

Instrumental diagnosis of ischemic colitis of the intestine involves the implementation of:

Ultrasound of the abdominal organs with dopplerography;
ECG - to monitor the functioning of the heart;
functional tests using a stationary bike or treadmill - to study how the patient tolerates physical activity;
intestinal irrigoscopy;
colonoscopy - to evaluate the inner surface of the large intestine;
biopsy - carried out during the previous procedure and is aimed at taking a small part of the affected organ for subsequent histological analyzes;
endoscopic laparoscopy - to examine the abdominal organs.

Differential diagnosis of such an ailment is carried out with:

various diseases of infectious etiology;
Crohn's syndrome;
oncology;
ulcerative colitis of a nonspecific nature.

Treatment

Elimination of ischemic colitis requires an integrated approach and includes:

adherence to a sparing diet - dietary table number five is taken as a basis;
taking medications such as vasodilators, mild laxatives and antiplatelet drugs;
detoxification therapy - such treatment is necessary in case of a severe course of the disease;
normalization of water and electrolyte balance;
blood transfusion;
antibiotic therapy.

Surgical intervention is indicated when complications are detected and is aimed at excising the affected part of the large intestine.

Complications

Late treatment quite often leads to the development of such consequences as:

partial or complete intestinal obstruction;
rupture of the wall of the affected organ;
pathological expansion of the affected organ;
intestinal hemorrhage;
peritonitis;
the formation of strictures;
oncology.

Prevention and prognosis

Due to the fact that ischemic colitis is a complication of many diseases, their timely elimination can be considered the only preventive measure. In addition, it is recommended to adhere to the rules of diet number 5.

The prognosis of the disease is often favorable, but depends on the age of the patient and his general condition, as well as on the presence of complications and concomitant ailments.

Chronic inflammation and diseases of the colon are among the most difficult areas of gastroenterology. Together with ulcers, infectious colitis, Crohn's disease, microscopic and ischemic colitis have spread.

Ischemic colitis is an inflammation of the colon as a result of the development of its ischemia, that is, an acute or chronic violation of the blood supply to its mucous membrane.

Blood enters the large intestine from the inferior and superior mesenteric arteries. The superior artery provides nutrients to the ascending, colon, and cecum, while the inferior artery fills the left intestine with blood. With intestinal ischemia, bacteria and microbes of the pathogenic microflora that live inside it are activated, as a result, inflammation of the mucous membrane develops.

Often, the disease affects the bend of the spleen and the left intestine.

causes of ischemic colitis

In fact, there are enough reasons for the development of this disease.

These include:

atherosclerosis of the inferior or superior mesenteric artery (mesenteric);
compression of blood vessels;
the appearance of a tumor-like formation;
the presence of adhesions;
enlarged lymph nodes;
defects in the development of blood vessels;
development of microspherocytic anemia;
dysplasia of the fibrous-muscular type;
damage to the inner lining of the heart as a result of infection;
inflammation of the walls of blood vessels (vasculitis);
joint inflammation (arthritis);
inflammation of the veins and arteries (Buerger's disease, panarteritis);
vascular disease (aortoarteritis);
the development of allergic reactions;
abdominal aneurysm surgery;
gynecological operations;
transfusion of blood incompatible with the patient's blood group;
operations on the stomach and intestines;
malnutrition, poisoning.

A common cause of the onset of the disease is a violation of blood flow, which occurs when
blockage of a small artery, it supplies blood to a specific part of this internal organ.

In its course, inflammation is acute and chronic. The acute form is characterized by severe pain, temporary in nature, attacks of nausea and vomiting, bleeding, fever. The chronic form of ischemic colitis is expressed in constant abdominal pain, stool disturbance, vomiting, frequent nausea, belching, weakness, sleep disturbance, weight loss. The affected part of the intestine narrows. Chronic colitis can be lifelong and must be periodically treated with medication.

Ischemic colitis symptoms

The first thing that occurs is pain in the abdomen. The pain appears half an hour after eating and lasts more than an hour. Most of all, it is felt in the left side of the abdomen and iliac region or in the area of the bend of the spleen, maybe near the navel. If fibrous strictures develop in the intestine, then the pain is permanent.

In this case, dyspeptic disorders appear:

suppression of appetite;
attacks of nausea, vomiting;
severe bloating and cramping after eating;
diarrhea and constipation.

With an exacerbation of the disease, a person often suffers from loose stools. Because of the pain, the desire to eat decreases, as a result, the process of absorption of nutrients is disrupted, the patient begins to lose weight. Tenesmus appears - a false sensation of the need to go to the toilet. Most patients have bleeding inside the colon, their intensity can be different, from a small amount in the stool to a serious discharge of blood in the rectum.

Bleeding occurs as a result of the appearance of erosions and ulcers on the mucous membrane. With an exacerbation, the abdomen takes on an acute shape, strongly strains. On palpation, pain is noted in its left side and iliac region, as well as diffuse sensitivity.

If blood flow is disturbed by narrowing of the artery or its spasm, then there is a high risk of a lack of blood supply, then the mucous and muscular membranes are affected. Fibrous stenosis occurs. If the ischemia is insignificant, then the mucous membrane is not significantly damaged. If large vessels of the peritoneum are clogged, necrosis of the walls of the organ develops, followed by inflammation of the peritoneum.

The stage of "sacs" in the development of ischemic colitis is a late sign of an irrigoscopic examination. If you experience pain in the abdomen, bleeding and diarrhea with bleeding, you should immediately consult a doctor to undergo an irrigoscopy.

An important radiological sign of IBTC is a symptom Thumbprint... It is manifested by the presence of rounded defects (sacs) in the wall, they appear due to hemorrhages in the submucosal layer. If the form of inflammation is reversible, then these sacs dissolve on their own in a few days or hours.

If the stage of the disease is more severe, then the mucous membrane is rejected over the area where the hemorrhage occurred, as a result, an ulcer is formed.

What most often affects the disease called ischemic colitis, which organs are affected more? The vulnerable area of the lesion is the splenic flexure of the colon. The disease also affects the left bend of the sigmoid colon. As a result of impaired blood flow, erosion and ulcers are most often formed on the wall.

diagnosis of ischemic colitis

Often, inflammation develops in people over the age of 60. The doctor examines the patient by palpation and auscultation. When probing the abdomen, the patient complains of pain in the left side of the peritoneum and left hypochondrium. A hardened aorta is felt in the mesogastric region, which hurts and throbs strongly. When listening, a systolic murmur is heard near the xiphoid process.

Diagnostics also includes a biochemical blood test, it shows the level of protein, albumin and iron. Colonoscopy is done after acute symptoms have subsided. With its help, it is possible to detect hemorrhagic lesions in the mucous and submucous layer, ulcers, strictures, areas of edema.

An abdominal X-ray shows the air content in the corner of the spleen. Determination of a decrease in the lumen of arteries can be done using Doppler ultrasonography and angiography. Biopsy of mucosal tissue allows histological verification of the lesion and its degree. Timely diagnostics allows you to prescribe the correct treatment, which will help to avoid serious complications of the disease.

Treatment of ischemic colitis

With the initial development of inflammation, the patient must follow a certain dietary diet, taking into account what disorders he has in the process of digesting food. You need to eat fractionally, 5-6 times a day, small portions. Exclude everything fried, spicy, pickled, smoked, fatty. So, with constipation, you need to eat foods containing a lot of fiber, prescribe laxatives, and with loose stools, you should refrain from peas, cucumbers, cabbage, milk, antidiarrheal drugs are prescribed.

Treatment includes taking various medications, depending on the severe symptoms. The appointment of glucocorticosteroids in the inflammatory process is contraindicated, because they can prevent the doctor from seeing the real picture of organ perforation.

In most cases, if there is an ulcer on the mucous membrane, there is a small amount of blood that enters the organ, as well as secretions in the feces. They go away on their own after a while after the pain disappears and the mucous membrane heals. The recovery period can take 2 to 4 weeks.

Diagnostics

The presence of ischemic colitis can be suspected in elderly patients with abdominal pain that began acutely in the left iliac region, combined with diarrhea, nausea, vomiting, and subsequent rectal bleeding. Also, the presence of ischemic colitis is possible in the elderly in the presence of diarrhea mixed with blood (excluding other causes - polyp, carcinoma, diverticulitis or angiodysplasia).

Confirmation of the diagnosis is carried out using objective research methods (irrigography, angiography, endoscopy).

Diagnostic goals
- Determination of the localization and prevalence of the lesion.
- Timely identification of complications.

Diagnostic methods for ischemic colitis
- Taking anamnesis
  When taking anamnesis, one should find out the location and nature of the pain, as well as the relationship of pain with physical activity and food intake. It is necessary to clarify whether the presence of blood impurities in the feces. Determine the duration of the onset of symptoms and the dynamics of their development. It is important to find out information about the presence of various chronic diseases in the patient.
- Physical examination
  - Inspection.
    Patients are usually undernourished, asthenic, but these changes are not always observed. Patients are often irritable, emotionally labile, withdrawn.
  - Palpation of the abdomen.
    There is pain in various parts of the abdomen, mainly in the left and lower parts, splash noise, moderate bloating. On palpation of the abdomen, a thickened, painful, pulsating abdominal aorta in the mesogastric region can be determined.
  - Auscultation of the abdomen.
    In 60% of cases, a systolic murmur is heard above the abdominal aorta, the maximum listening point of which can be located variable: in 56% - 2-4 cm below the xiphoid process (point II), in 13% - along the midline 2-4 cm below navel (V point), in 15% - 2–3 cm higher from point II (VII point), in 6% - in the region of the xiphoid process (I point). The noise is conducted at a limited distance (1–2 cm).
    
    Systolic murmur is one of the most reliable signs of the diagnosis of abdominal ischemic disease, however, with a sharp stenosis or occlusion of the vessel, it may be absent, which is not a reason to exclude ischemic damage to the abdominal organs.
    
    With bacterial colitis such as bacillary dysentery, salmonellosis and campylobacter colitis against the background of an acute course, segmental lesions of the colon can be observed. Moreover, with bacterial colitis and ischemic colitis, there is a similarity of manifestations on the mucous membrane in the affected segments: hyperemia, edema and erosion. For differential diagnosis, bacteriological examination of feces is important.

At the present time, medicine knows many diseases. Often people are struck by ailments that are associated with the digestive system. One of these is ischemic colitis.

What is this disease and can it be cured?

General information about the disease and the reasons for its development

Ischemic colitis refers to a disease that leads to impaired blood circulation in the vascular tubules of the large intestine. With difficulties with the movement of blood, the affected area experiences a lack of blood, which leads to a deterioration in its functionality and damage to the mucous membrane.

In the affected area, inflammation often develops that directly affects the immune function. Dysbiosis and other serious diseases develop.

Ischemic colitis can manifest itself for a variety of reasons, but experts distinguish the most common in the form:

atherosclerosis of the vascular system, where the deposition of fatty layer is observed;
decrease in blood flow in the intestinal canal;
education of blood clots in the vessels;
the development of an inflammatory process in the intestinal vessels;
deterioration of blood clotting;
aortic dissection;
sickle cell anemia;
liver transplant;
obstruction of the intestinal canal;
the occurrence of tumor-like formations;
the presence of colitis of the idiopathic type.

In this case, ischemic colitis is divided into several subtypes:

reversible. The blood flow in the vascular system is not often disturbed. But as a result of this process, inflammation occurs, which then passes;
stenosing with irreversible changes. The blood flow is disrupted and this is permanent. The abnormal process is progressing more and more every day. Because of this, scars form on the intestinal walls;
gangrenous. This type of ailment is considered the most serious and dangerous not only for the patient's health, but also for his life. All wall layers are affected.

Ischemic colitis also happens:

acute character;
chronic in nature.

The intestine can lead to partial or complete tissue necrosis. Chronic disease occurs with mild symptoms.

In advanced situations, there is a narrowing of the lumens in the vessels.

Symptoms

Signs of intestinal ischemia do not appear immediately. At first, they are mild. The disease develops very slowly.

If the patient has ischemic colitis, symptoms will manifest in:

painful sensations in the abdomen. They are especially pronounced after eating food after fifteen to twenty minutes, while their duration is from one to three hours;
decreased appetite, bloating, nausea, belching with air or food;
difficulty with stool. Constipation, diarrhea, or alternation with each other may occur;
rapid weight loss. This process is caused by poor absorption of food;
the development of bleeding from the rectum. This phenomenon manifests itself against the background of erosions and ulcers that have formed on the mucous membrane;
tension of the walls of the peritoneum, irritation of muscle structures. On palpation, the patient complains of severe pain and increased sensitivity.

In addition, the patient may experience dizziness, disturbed sleep and rest, painful sensations in the head, increased temperature, a feeling of chills and increased sweating.

In older people, pressure can jump, weakness and tremors can be observed.

If such symptoms persist for more than six hours, then the doctor may suspect the development of necrosis of the intestinal canal.

Diagnosis

Symptoms and treatment should be identified as soon as possible. When the first signs appear, it is necessary to urgently consult a specialist.

The doctor will listen to the patient's complaints and palpate the abdomen. Also, the doctor will try to analyze the development of the disease. Perhaps it was due to improper nutrition or congestion of the intestinal canal.

Special attention is paid to the history. The doctor is trying to find out whether the patient has had problems with the digestive system before, whether there are neoplasms, whether surgical interventions have been carried out and whether medicines have been used for a long time.

Then the temperature and pressure are measured. This diagnostic method will assess the severity of the disease.

At the same time, a general examination of the patient is performed. This will allow you to recognize the presence of other problems in the form of anemia, blood loss and difficulties with metabolic processes.

To confirm the diagnosis, the patient is prescribed a laboratory test.

The patient needs to donate blood, which determines the level of hemoglobin, leukocytes, ESR. These values make it possible to recognize latent anemia, iron deficiency, and inflammation. The blood test also reveals blood clotting, serum composition, and the ratio of fatty cell structures.

This is followed by a urine test. This method of diagnosis will help to see if the kidneys are dysfunctional and the presence of infectious agents.

The feces are checked for mucus, pus, and blood streaks. This may indicate certain disorders in the form of the presence of erosions and ulcers, infectious agents, dysbiosis.

Diagnostics is never complete without instrumental techniques. With ischemic colitis, electrocardiography of the heart muscle, ultrasound diagnostics of the abdominal cavity and aorta are performed.

As additional research methods, the following can be assigned:

laparoscopy;
doppler examination of the vessels in the abdominal cavity;
functional tests;
X-ray examination using a contrast agent.

All these methods of diagnosis make it possible to identify the presence of an ailment and the stage of its development.

Therapeutic measures for the disease

Treatment of the intestinal canal is based on three basic rules: drug therapy, strict diet and bed rest.

If, against the background of another disease, ischemic colitis has developed, treatment includes symptomatic therapy, but in this case more attention is paid to the root cause.

The duration of the treatment course is determined based on the condition and age of the patient. The older a person is, the more difficult it is to treat an ailment.

Treatments include:

normalization of hyper- and dyslipidemia. This will stop the development of atherosclerosis;
taking drugs, the effect of which is aimed at lowering blood viscosity. This will avoid the formation of clots and the development of thrombosis;
the use of medications with a vasoconstrictor character;
the use of hypoglycemic drugs;
the use of nitrates. They make it possible to stop pain syndrome;
carrying out symptomatic therapy. In case of pain, the patient is advised to take No-Shpu, with high temperature indicators - antipyretic drugs;
taking enzyme medications;
the use of essential phospholipids;
normalization of weight.

In more advanced cases, the patient undergoes surgery to remove the affected area in the large intestine.

Diet

With ischemic colitis, it is very important to normalize nutrition.... A patient with this ailment should avoid diarrhea, constipation, and dysbiosis. Therefore, diet number five is prescribed.

It implies the exclusion of products in the form of:

pickled products;
rich products;
soups with meat and mushroom broth;
fatty dishes and lard;
fried eggs;
radishes, green onions and spinach;
hot spices;
chocolate and other sweets;
alcoholic beverages;
cocoa and black coffee.

With ischemic colitis, the diet should include:

drinks in the form of fruit drinks, compotes, jelly, tea;
eggs. Moreover, their number should not exceed one piece per day;
bread made from wheat and rye flour;
vegetable oil, olive or linseed oil;
low-fat cottage cheese;
low-fat cheese;
porridge on the water in the form of buckwheat, rice, millet, oatmeal;
greens;
vegetables and baked fruits;
vegetable broth soups;
lean meat. Young veal, turkey, rabbit and chicken are best.

You should eat in small portions five to six times a day. In this case, breaks between meals should be approximately two to three hours.

It is also necessary to direct all efforts to strengthen the immune function. To do this, periodically you need to drink vitamin complexes, immunomodulatory agents.

Complications

In the absence of timely treatment, the disease gradually becomes neglected.

If you do not pay attention at all to the symptoms that appear, then the patient may experience complications in the form of:

intestinal obstruction;
perforation of the intestinal canal;
rupture of the walls of the intestinal canal and infection of the abdominal cavity;
megacolon of a toxic nature;
bleeding of a massive nature;
anemia and iron deficiency;
anorexia.

These processes require urgent assistance from specialists. If the intestinal cavity is damaged, surgical intervention is performed.

In the absence of medical assistance, the patient will die.

Preventive measures

To prevent the development or re-exacerbation of the disease, you must follow some preventive recommendations:

Nutrition must be correct. You should not consume alcoholic beverages, fast foods and semi-finished products.
Monitor the condition of the intestinal canal. Avoid diarrhea, constipation and dysbiosis.
Include moderate physical activity. Exercise every morning.
Walk more in the fresh air.
Normalize sleep and rest.
Boost immune function.

Ischemic colitis refers to a serious disease that requires a strict regimen from the patient. The disease can develop at any age. In this case, the disease is dangerous for its complications. Therefore, you should not postpone the visit to the doctor.