Chronic ischaemic bowel diseases in the aged--go with the flow

Intestinal ischaemia is caused by a reduction in intestinal blood flow. This entity is being increasingly recognised as a cause of abdominal symptoms but is often not diagnosed accurately. Chronic mesenteric ischaemia (intestinal angina) refers to chronic post-prandial abdominal pain caused by intestinal hypoperfusion usually related to atherosclerosis. Colonic ischaemia refers to colonic injury as a result of hypoperfusion and is also referred to as ischaemic colitis.

Review of the English-language medical literature, with the key words diagnosis, treatment, chronic mesenteric ischaemia and colonic ischaemia.

There is a lack of evidence based on randomised controlled clinical trials for both the diagnosis and treatment of mesenteric ischaemia. A high index of clinical suspicion is important to facilitate rapid diagnosis. Chronic mesenteric ischaemia can be accurately diagnosed by non-invasive CT and MRI techniques, and less so by duplex ultrasound. In order to confirm the diagnosis, demonstration of the involvement of at least two of the main splanchnic vessels is required. Successful treatment involving both percutaneous and surgical revascularisation is available. Colonic ischaemia requires sequential diagnostic techniques and the majority of cases resolve with supportive treatment. More severe cases may require surgical intervention.