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Colonic ischemia

Peter Grubel, MD
J Thomas Lamont, MD
Govind Nandakumar, MD, FACS, FASCRS
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Martin Weiser, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Intestinal ischemia is caused by a reduction in blood flow to a level that is insufficient for the delivery of oxygen and nutrients required for cellular metabolism [1]. It can be related to acute arterial occlusion (embolic, thrombotic), venous thrombosis, or hypoperfusion of the mesenteric vasculature causing nonocclusive ischemia. The incidence is estimated at 16 cases per 100,000 person-years, which has increased over time [2].

Colonic ischemia is the most frequent form of intestinal ischemia, most often affecting older adults [3]. Colonic ischemia may be more prevalent in women. Colonic ischemia should be suspected in patients with lower abdominal pain and bloody diarrhea or hematochezia; however, these symptoms are nonspecific.

Approximately 15 percent of patients with colonic ischemia develop gangrene, the consequences of which can be life-threatening, making rapid diagnosis and treatment imperative. Nongangrenous ischemia is usually transient and resolves without sequelae [4]. However, some of these patients will have a more prolonged course or develop long-term complications, such as stricture or chronic ischemic colitis.

The diagnosis and treatment of colonic ischemia can be challenging since it often occurs in patients who are debilitated and have multiple medical problems.

The clinical features, diagnosis, and treatment of ischemia affecting the colon and rectum will be reviewed here. Acute and chronic intestinal ischemia of the small intestine are discussed separately. (See "Overview of intestinal ischemia in adults" and "Chronic mesenteric ischemia".)

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Literature review current through: Nov 2017. | This topic last updated: Feb 14, 2017.
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