Practice Clinical updates

Ischaemic colitis

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6600 (Published 22 December 2016) Cite this as: BMJ 2016;355:i6600
  1. J M Trotter, specialist registrar in general surgery1,
  2. L Hunt, specialist registrar in diabetes and endocrinology2,
  3. M B Peter, consultant general surgeon1
  1. 1Department of Surgery, Scarborough General Hospital, Scarborough YO12 6QL, UK
  2. 2Department of Diabetes, Endocrinology and Metabolism, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  1. Correspondence to: J M Trotter j.trotter{at}nhs.net

What you need to know

  • Ischaemic colitis is different from mesenteric ischaemia or “ischaemic bowel”

  • Ischaemic colitis is typically acute in onset and has a high mortality rate

  • Patients with suspected ischaemic colitis need urgent admission to a gastroenterological unit with specialist surgical services

  • Some patients with ischaemic colitis can be managed conservatively

  • Computed tomography is the investigation of choice for initial diagnosis of ischaemic colitis, using colonoscopy within 48 hours to give further prognostic information and to confirm diagnosis

The incidence of ischaemic colitis1 has risen from 6.1 cases/100 000 person-years in 1976-80 to 22.9/100 000 in 2005-09.2 Acute gastrointestinal medical and surgical teams will see a few patients with ischaemic colitis each month. Prevalence increases with age and comorbidity,2 which might lead to an increase in the incidence of ischaemic colitis as the population ages.3 A small proportion of patients will present with a more chronic form of ischaemic colitis.

This article provides practical advice to non-specialists regarding the diagnosis, management, and guideline recommendations for ischaemic colitis in the acute setting.

What is ischaemic colitis and what causes it?

Ischaemic colitis and mesenteric ischaemia are different disorders but are often confused: table 1 highlights their differences. Ischaemic colitis occurs when there is an acute, transient compromise in blood flow, below that required for the metabolic needs of the colon. This leads to mucosal ulceration, inflammation, and haemorrhage. The duration and severity of hypoperfusion determines whether the colonic injury is predominantly ischaemic or as a consequence of reperfusion.4Figure 1 shows the arterial supply of the colon and the most common sites for ischaemic colitis.

View this table:
Table 1

Differences between mesenteric ischaemia and ischaemic colitis

Fig 1 Arterial supply of the colon and the most common sites for ischaemic colitis. The colon receives blood from both the superior and inferior mesenteric arteries. However, there are weak points, or “watershed” areas, at …

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