Ischemic colitis as a cause of severe hematochezia: A mini review

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Internal Medicine

Background:

• Ischemic colitis (IC) is a significant cause of severe lower gastrointestinal bleeding (LGIB), particularly in the elderly population.
• Limited literature exists on IC as a primary cause of severe LGIB, necessitating a comprehensive review.

Purpose of the Study:

• To review the diagnosis, colonoscopic findings, medical treatment strategies, and clinical outcomes for patients presenting with severe hematochezia due to IC.
• To evaluate the efficacy and safety of colonoscopic hemostasis and surgical interventions in managing IC-related severe bleeding.

Main Methods:

• Literature review focusing on diagnosis, colonoscopic findings, and treatment modalities for ischemic colitis.
• Analysis of outcomes based on treatment approach (medical vs. surgical) and patient setting (inpatient vs. outpatient).

Main Results:

• The majority of severe hematochezia cases from IC are manageable with medical treatment.
• Colonoscopic hemostasis using hemoclips is a safe and feasible option for focal ischemic ulcers with major hemorrhage stigmata.
• Colon surgery is reserved for patients refractory to medical treatment, experiencing ongoing severe bleeding, clinical deterioration, or peritoneal signs, and is associated with higher morbidity.

Conclusions:

• Medical management is effective for most patients with severe hematochezia from IC.
• Colonoscopic interventions offer a viable alternative for managing active bleeding in focal ischemic ulcers.
• Surgical intervention for IC is associated with poorer clinical outcomes compared to medical management, highlighting the importance of early and appropriate treatment strategies.