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Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia
1Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
Gastroenterology Clinics of North America
|January 16, 1999
Summary
Ischemic colitis, a common vascular condition, often presents with varied symptoms and is diagnosed via colonoscopy. While most cases are managed non-surgically, some patients develop chronic issues or severe disease requiring intervention.
Area of Science:
- Gastroenterology
- Vascular Medicine
- Colorectal Surgery
Background:
- Ischemic colitis constitutes about 50% of mesenteric vasculopathy cases.
- Clinical presentation is diverse, influenced by obstruction extent, insult speed, collateral circulation, and comorbidities.
Purpose of the Study:
- To review the diagnosis, management, and outcomes of ischemic colitis.
- To highlight the characteristics of chronic mesenteric ischemia.
Main Methods:
- Diagnosis is typically confirmed through colonoscopy.
- Surgical intervention is reserved for approximately 20% of patients with peritonitis or clinical decline.
Main Results:
- About 20% of patients develop chronic colitis with symptoms like diarrhea, bleeding, or weight loss, potentially showing strictures or masses on endoscopy.
- Chronic mesenteric ischemia is often linked to severe atherosclerotic stenosis in multiple mesenteric arteries, presenting with postprandial pain, anorexia, and weight loss.
Conclusions:
- Ischemic colitis requires careful diagnosis and management, with a significant minority progressing to chronic forms or requiring surgery.
- Advanced mesenteric ischemia has a distinct clinical triad and is associated with multi-arterial atherosclerotic disease.