Table of Contents
- beware the patient with acute abdominal pain in the ED who also has atrial fibrillation - check their serum lactate level!
- 90% occur in >60 yr olds
- younger pts tend to have either:
- vascular disease
- arteriosclerotic heart disease
- vasoconstrictive drugs - cocaine, digoxin
- chronic ischaemia may be due to Sx, esp. AAA repair (0.1-10% of AAA repairs)
- most cases due to arteriole shunting, spasm or poor perfusion of mucosal vessels
- some cases are caused by embolus or thrombus of mesenteric artery
- most cases involve the splenic flexure with sparing of rectum as this is less dependent on inf. mesenteric A
there are three types:
- transient, reversible ⇒ mucosal sloughing and then regeneration (most common type)
- stricturing - haemorrhagic infarction of mucosa ⇒ ulceration, healing by fibrosis
- gangrenous - complete bowel wall infarction ⇒ perforation, peritonitis and death
- characteristically, acute onset
AXR and CT findings of ischaemic colitis
- most plain films are normal or show a non-specific ileus pattern!
- thickening of the colonic wall, with luminal narrowing and transverse ridging
- NB. pseudothickening of the wall is NOT a sign of ischaemia and may be due to:
- ascites as the loops are floating in fluid and become separated from other loops
- loops containing more fluid than air causing an optical illusion
- “thumbprinting” of the bowel wall due to oedema
- fixed, rigid, tubular, ahaustral bowel loops
- pneumatosis (gas in bowel wall):
- benign causes of pneumatosis include collagen vascular diseases, steroids, COPD and idiopathic causes.
- this can be seen in any severe bowel insult resulting in bowel wall necrosis and is a classic feature of necrotizing enterocolitis of the newborn infant.
- free gas in peritoneal cavity (uncommon) or in mesenteric veins and portal vein (these findings are ominous and indicate infarction)
colitis_ischaemic.txt · Last modified: 2018/08/10 15:29 by 127.0.0.1