The large intestine, also called the colon, is a portion of the intestine of approximately one and a half meters in length, responsible for storing organic waste to later be eliminated through the feces, it also houses the bacteria that are part of the normal flora from the intestine and absorbs some vitamins such as vitamin K.

The blood flow of the colon is guaranteed by the mesenteric vessels, so any disease that affects them can trigger a decrease in oxygen supply to the colonic tissues. When this occurs, ischemia or death of the colon can occur, which is called ischemic colitis, causing severe abdominal pain that can turn into a medical emergency.

What is ischemic colitis?

Ischemic colitis (also known as colonic infarction) is defined as a group of diseases that generate partial or total occlusion and loss of blood flow in the mesenteric vessels, causing the cell death of a segment or the entire colon.

The implication that a tissue does not get enough blood is that cells need oxygen and nutrients from the blood to live. This is how the loss of blood flow causes cell death of the colon epithelium. The same occurs when a coronary artery becomes blocked (causing a myocardial infarction) or when the flow of the middle cerebral artery slows (causing a stroke).

According to its severity, ischemia can be only at the level of the mucosa (superficial) or of all the layers of the colon wall.

The ischemic colitis is most common in people over 60, smokers and people with diseases such as atherosclerosis, chronic obstructive pulmonary disease, high blood pressure, high cholesterol and a history of myocardial infarction or cerebrovascular accident.

Causes of ischemic colitis

The causes for which the mesenteric blood flow can be slowed or occluded are numerous, therefore, most of the cases are due to the presence of an atheroma plaque (fatty structure in the intimal layer of the arteries) or a thromboembolism of the mesenteric artery.

However, there are other common causes, such as an aortic aneurysm, abdominal trauma (blunt and from gunshot wounds), abdominal surgeries, hypovolemic and distributive shock, disseminated intravascular coagulation, large vessel vasculitis, and any prothrombotic state such as presence of cancer, abuse of illicit drugs such as cocaine or methentamines, autoimmune diseases, long-term use of oral contraceptives and chronic smoking, among others.

What are the symptoms of ischemic colitis?

Symptoms vary according to the degree of obstruction and loss of blood flow to the mesenteric vessels. Some symptoms of ischemic colitis are:

• Abdominal pain: Generally, the pain is of unexpected onset, of strong intensity, located in the lower part of the abdomen or throughout the abdomen, which prevents the performance of daily activities. When ischemia is mild, colicky pain can be generated that gradually increases in intensity.
• Vomiting: The pain caused and the lack of motility of the colon can generate symptoms such as nausea and vomiting of food content.
• Diarrhea: After ischemic colitis there is an alteration of the intestinal transit, so that all its contents will be constantly expelled in the form of diarrhea. This may or may not be accompanied by blood.
• Lower digestive hemorrhage: in severe cases where ischemia and necrosis of the colon tissue occurs, blood vessels are exposed causing a lower digestive hemorrhage called rectorrhage (in the form of living blood expelled through the rectum).
• Fever: some patients have thermal rises associated with ischemic colitis.

When to go to the emergency area?

It is important that the patient is aware of some situations that warrant emergency evaluation. For example, a person who presents a digestive hemorrhage due to any cause, should immediately consult an emergency area to establish the diagnosis, since in a few hours the body can trigger a hemodynamic failure due to blood loss, which can lead to be a deadly condition.

On the other hand, a patient with sudden onset, limiting abdominal pain that sets in and worsens within a few hours should be evaluated immediately to rule out a surgical emergency.

The doctor will rule out other differential diagnoses such as biliary or appendicular starting point peritonitis, acute diverticulitis, colonic abscesses, intestinal perforations, intestinal tumors and intestinal obstruction, among others. For this, he will request complementary studies (radiography, abdominal tomography, abdominal ultrasound, angiography, among others) that allow determining the cause of abdominal pain.

It is important that the person who presents any type of abdominal pain does not self-medicate and always consult the doctor, in order to make an accurate diagnosis of the pathology that is causing the symptoms.

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Revista Organizações em Contexto (ROC) - Diretoria de Pesquisa e Pós-Graduação - Universidade Metodista de São Paulo - UMESP.

ISSN Versão Eletrônica 1982-8756

ISSN Versão Impressa 1809-1040 (2005-2008)

Este obra está licenciado com uma Licença Creative Commons Atribuição-NãoComercial 4.0 Internacional.