home Auditorium 7 Treatment methods for ischemic intestinal colitis. Ischemic colitis, description of the disease, risk group, treatment methods Clinical picture of the disease

Treatment methods for ischemic intestinal colitis. Ischemic colitis, description of the disease, risk group, treatment methods Clinical picture of the disease

Poor circulation (ischemia) of the intestinal vessels can cause a lack of blood in certain areas of the large intestine. Subsequently, an inflammatory process of the intestinal walls begins in this area, which leads to acute pain, bowel dysfunction, weight loss, and sometimes even to a stricture (narrowing of the intestine) in this area. In medicine, this disease is called ischemic intestinal colitis.

Causes

Scientists have proven that the large intestine is one of the least blood-supplied internal organs. And in case of injuries, imbalance of internal balance, internal damage to the intestinal walls, infection, blood flow decreases to critical levels. As a result, there is a risk of developing ischemia. Which in turn leads to ischemic intestinal colitis.

Also, the causes of the development of this disease include the following phenomena:

Vascular spasms due to atherosclerosis. An increase in the amount of fat on the walls of blood vessels;
Reduced blood pressure;
Formation of thrombi (blood clots) in blood vessels;
Aortic dissection or damage. As a rule, it is accompanied by anemia of internal organs and dehydration of the body;
DIC syndrome. Large-scale blood clotting in various vessels;
Liver transplant. The body does not accept the new organ;
Tumor formation in the intestine and its obstruction;
Sickle cell anemia. Violation of the structure of the hemoglobin protein. The protein takes on a sickle shape, resulting in an imbalance in oxygen balance. This disease is hereditary.

Varieties

There are several forms of this intestinal disease: acute and chronic colitis. When acute ischemic colitis is diagnosed in the human body, the organs of the intestinal mucosa die.

With the mild variety, cell death occurs only on the lining of the intestinal wall. In the worst case, tissue death may occur within the wall (intramural infarction), or all layers of the intestine may be damaged (transmural infarction).

In the chronic form of the disease, the patient experiences nausea, gag reflexes after eating, constipation alternating with loose stools, and constant sharp pain in the abdomen. As a rule, chronic colitis leads to intestinal stricture, and intestinal deformation (narrowing) occurs. And this has a beneficial effect on the further development of intestinal diseases, and can affect the development of intestinal gangrene and the appearance of ulcers.

Symptoms

Typically, patients experience constant abdominal pain. Depending on the location of the damage to the colon, the source of pain may be in the left or right side of the abdomen. Sometimes the pain can be stabbing. Painful sensations can be in the form of short attacks of 10-15 minutes, or be constant. Specific sensations depend on the severity of the disease, and the pain can be aching, dull, pressing or intense, cutting, sharp. Usually the patient experiences pain in the intestinal area after eating. This happens almost immediately. The pain goes away after a few hours.

Foods such as sickly sweet, spicy, scalding foods, and dairy products can cause exacerbation of pain. Pain can also occur after physical activity. For example, long walking, heavy lifting, prolonged work in an uncomfortable bent position.

Another obvious symptom is loose stools with a lot of bloody or purulent discharge. Traces of blood, mucus and pus residues appear on the walls of the rectum. The amount of discharge depends on the shape and severity of intestinal damage. With the initial disease, they may not be present at all in the feces, but the smell of rot will already be present. Usually, at the first symptoms, diarrhea gives way to constipation and back.

Other symptoms characterizing ischemic colitis also include:

Diagnostics

As a rule, ischemic colitis is an age-related disease. About 80% of patients with this diagnosis are over 50 years of age. To determine the disease, doctors conduct a general examination and pay attention to the patient’s complaints and lifestyle. They analyze what could lead to such an intestinal disease. For example, a patient has undergone surgery or has been diagnosed with a tumor. Constant intake of certain medications, alcohol, and spicy foods can cause such abnormalities to occur.

After the external examination, laboratory tests follow:

General blood analysis. Helps identify signs of anemia, lack of hemoglobin and red blood cells (erythrocytes). An increase in the number of leukocytes (white blood cells) is a clear sign of inflammation.
Analysis of urine. Aimed at detecting renal failure and infection of internal organs.
Stool analysis. If blood, mucous deposits, or purulent discharge are detected, we can accurately state that there is a disorder of the digestive system.
Blood chemistry. Blood testing for cholesterol and its fractions, checking the level of lipid ratio, protein and iron content in the blood, determining blood clotting indicators.

But the most effective method for determining ischemic colitis is instrumental research. These include:

Colonoscopy. One of the most effective methods. Typically performed in combination with a biopsy. The patient's large intestine is examined using a special device - an endoscope. This procedure allows you to see the inside of the intestinal wall and assess their condition. During a biopsy, a small piece of intestine is additionally taken for subsequent more detailed analysis and an accurate diagnosis.
Irrigoscopy. Examination of the intestine using X-rays. This method allows you to fairly accurately determine the degree of intestinal damage. And also detect strictures and affected areas.
Ultrasound examination. Ultrasound of the abdominal aorta is used to identify affected cells and vessels. In this way, it is possible to detect the formation of fatty deposits on the walls of blood vessels.
Doppler study. Helps determine the condition of the arteries.
Laparoscopy. This method includes surgery. Several small holes are made in the patient's abdominal cavity. This is necessary to insert an endoscope - a device for examining internal organs. After examining and assessing the damage, an operating instrument can be inserted through these holes and treatment can be performed.
Electrocardiography. Using an ECG, fluctuations in electric fields are recorded, which makes it possible to identify abnormalities in the functioning of the intestines.

Treatment

In the initial stages of the disease, treatment mainly consists of eating certain foods and following a strict diet. It depends on the symptoms of the disease. For constipation, the patient is advised to eat foods high in fiber. Mild laxatives are prescribed. For loose stools, antidiarrheals are used. Animal fats are replaced with fats of vegetable origin. There is a trend towards reducing and completely avoiding spicy, fatty and fried foods. To boost immunity and normalize the functioning of the body as a whole, vitamin complexes are prescribed.

If these methods do not help, doctors carry out antiplatelet therapy aimed at reducing blood viscosity. Vasodilators, enzymes, and phospholipids are prescribed. These medications are aimed at normalizing the water-alkaline balance and intestinal function in general. In some cases, a blood transfusion may be necessary.

Surgical treatment is indicated in severe cases when the diagnosis is made too late and medications are not able to cope with the infection. The affected area is removed, an inspection is carried out and a special drainage is installed.

Consequences and complications

Unfortunately, complications after such operations are quite normal. Since the patients are quite old, the body is not able to immediately rebuild and normalize all its basic processes. After surgery, the patient may experience intestinal obstruction. Food either passes through the intestines too slowly, with difficulty, or does not pass at all, causing flatulence, bloating, nausea and vomiting reflexes.

Sometimes the intestinal wall can rupture, leading to infection throughout the body. The negative consequences of intestinal colitis also include an increase in the size of the large intestine and excessive hemorrhage.

Prevention

In most cases, ischemic colitis occurs as a result of complications of atherosclerosis, during postoperative restoration of internal organs, or serious heart failure. Therefore, prevention is based on effective treatment of these diseases.

Periodic examinations by a gastroenterologist, proctologist and in the general surgery department can prevent intestinal diseases at the initial stage and get rid of them with the help of special diets and vitamins. People diagnosed with chronic ischemic colitis should completely change their diet. Add fresh fruits and vegetables, low-fat meat, and cereals to your daily diet. Avoid excess fatty fish and meat products, mustard, pepper, sweet foods, coffee and alcoholic beverages. With this diet, the likelihood of necrosis and similar complications is reduced, and intestinal function is normalized without surgical intervention.

Studying the symptoms of the disease will also be useful. Knowing such information is never superfluous, because it is better to always remain on guard. The sooner the progression of the disease is revealed, the easier and faster the treatment will be.

There are factors that cause inflammation of the large intestine and, as a consequence, ischemic colitis. This disease is relatively rare, but is most often identified among older people. In most cases, after appropriate treatment, patients recover, but sometimes death occurs due to the development of sepsis.

Ischemic colitis (IC) is a disease in which inflammation and damage to the colon results from insufficient blood supply. IR can contribute to the occurrence of ischemic necrosis of varying severity, which often varies from superficial mucosal to transmural necrosis of the colon.

Marston et al first used the term “ischemic colitis” in their article published in 1966. This report was preceded by a description of reversible colonic vascular occlusion by Boley and colleagues in 1963.

Ischemic colitis is usually suspected based on clinical presentation, physical examination, and laboratory results. Additionally, the diagnosis can be confirmed by endoscopy or the results of the use of a sigmoid or endoscopic spectroscopic catheter with illumination. Most patients recover completely after CPB. Sometimes, after severe ischemia, patients may develop long-term complications such as stricture or chronic colitis.

Video Colitis. Colon disease

Description

The term “colitis” (lat. colitis) comes from the Greek. kolon - large intestine and Greek. itis is an inflammatory process. The definition of “ischemic” indicates a violation of normal blood circulation, as a result of which nutrition and oxygen transmission to the cells of the organ, in this case the colon, suffers.

Normally, the colon receives blood from the superior and inferior mesenteric arteries. The circulatory network of these two main vessels is a fairly large area with abundant collateral circulation. Impaired blood flow causes damage to the lining of the colon, causing ulcers/erosions and bleeding.

Development of ischemia

Under normal conditions, the colon receives 10% to 35% of the total cardiac output. If blood flow to the intestine is reduced by more than 50%, ischemia will develop. The arteries supplying the intestine are very sensitive to vasoconstrictors; This appears to be an evolutionary adaptation to redirect blood from the gut to the heart and brain during times of stress. As a result, low blood pressure causes the arteries supplying the colon to become excessively constricted. A similar process may result from the action of vasoconstrictor drugs such as ergotamine, cocaine, or vasopressors. This vasoconstriction can lead to non-occlusive ischemic colitis.

The following parts of the colon are most susceptible to ischemia:

splenic angle region
descending colon
upper rectum

Severity of ischemic colitis

Ischemic colitis may develop a variety of features indicating appropriate clinical severity.

Mild - mucosal and submucosal hemorrhages and swelling are visible, possibly with mild necrosis or ulceration.
Moderate - there is a pathological picture reminiscent of inflammatory bowel disease (that is, chronic ulcerations, abscesses and pseudopolyps).
Severe degree - a transmural infarction with resulting perforation is determined. After recovery, muscle tissue may be replaced by connective tissue, resulting in a stricture. Also, once normal blood flow is restored, reperfusion injury may contribute to colonic injury.

Facts and statistics on ischemic colitis:

The disease is detected in one patient out of 2000 hospitalized, and is also observed in approximately one patient out of 100 examined endoscopically.
More than 90% of cases occur in people over 60 years of age, so ischemic colitis is considered a disease of older people.
Men and women suffer from IR equally often.

Causes

There are two main causes of ischemic colitis, according to which the disease is classified into non-occlusive ischemic colitis and occlusive.

Non-occlusive ischemia occurs due to insufficient blood pressure or narrowing of the vessels supplying the colon. Occlusive ischemia occurs when a blood clot or other abnormality blocks blood from reaching the colon.

Non-occlusive ischemia

In hemodynamically unstable patients (ie, those in shock), mesenteric perfusion may be impaired. This condition is usually asymptomatic and occurs only with a systemic inflammatory response.

Occlusive ischemia

Mainly develops due to thromboembolism. An embolus enters the blood supply of the colon, usually due to atrial fibrillation, valvular disease, myocardial infarction or cardiomyopathy.

In addition, ischemic colitis is a common complication of repair therapy after abdominal aortic aneurysm, when the formation of the inferior mesenteric artery is closed with an aortic graft.

In a 1991 review of 2137 patients, the most common cause (74%) of ischemic colitis was incomplete ligation of the mesenteric artery.

Thus, patients without adequate treatment are at risk of ischemia of the descending and sigmoid colon. Bloody diarrhea and leukocytosis in the postoperative period essentially allow the correct diagnosis of ischemic colitis.

Video Ischemia: causes, symptoms, diagnosis, treatment and pathology

Risk factors

The presence of the following factors increases the risk of developing ischemic colitis:

Determination of fatty deposits on artery walls (atherosclerosis)
Excessively low blood pressure (hypotension), which may be due to heart failure, major surgery, trauma, or shock
Intestinal obstruction caused by a hernia, scar tissue, or tumor
Surgeries performed on the heart, blood vessels, digestive organs, or gynecological system
Other medical disorders that affect circulation, such as inflammation of the blood vessels (vasculitis), systemic lupus erythematosus, or sickle cell disease
Use of cocaine or methamphetamine
Colon cancer (in rare cases)

Clinic

Three phases of development of ischemic colitis are described:

The hyperactive phase, which most often manifests itself as severe abdominal pain and bloody stools. Many patients feel better during this phase and the disease does not progress further.
The paralytic phase develops with ongoing ischemia. Abdominal pain may occur, often spreading, the abdomen becomes more tender to the touch, and bowel motility decreases, leading to bloating, further bloody stools, and absence of bowel sounds on auscultation.
The final phase, or state of shock, develops as fluid begins to seep through damaged colon tissue. This can lead to shock and metabolic acidosis with dehydration, low blood pressure, tachycardia and confusion. Such patients are often in critical condition and require intensive care.

Symptoms of ischemic colitis vary depending on the severity of the ischemia. The most common early signs of ischemic colitis are abdominal pain (often left-sided), with mild to moderate amounts of loose stool.

Of the 73 patients with IR, the following frequency of occurrence of various symptoms was determined:

abdominal pain (78%)
bleeding (62%)
diarrhea (38%)
fever above 38°C (34%)

On physical examination:

abdominal pain (77%)
abdominal tenderness (21%)

The risk of serious complications increases if the patient has symptoms of the lesion localized on the right side of the abdomen. This is because the arteries that supply the right side of the colon also supply part of the small intestine, so its supply may also be blocked. With this type of ischemic colitis, pain tends to be more severe and has a poor prognosis.

Blocked blood flow to the small intestine can quickly lead to death of the entire intestine (pannecrosis). In such cases, it is often necessary to remove part of the digestive tract.

When should you see a doctor?

Seek immediate medical attention when you experience sudden, severe abdominal pain. Painful sensations may not allow the patient to sit quietly or take a comfortable body position.

You need to see a doctor when bloody diarrhea is detected. Early diagnosis and treatment can help prevent serious complications.

Diagnostics

Ischemic colitis must be differentiated from many other causes of abdominal pain and rectal bleeding (eg, infection, inflammatory bowel disease, diverticulosis, or colon cancer). It is also important to distinguish ischemic colitis, which often resolves on its own, from a more dangerous condition such as acute mesenteric ischemia of the small intestine.

There are methods to check whether enough oxygen is being delivered to the colon. The first device, approved in the US in 2004, is based on visible light spectroscopy and is used to analyze capillary oxygen levels. Its use during the repair of an aortic aneurysm makes it possible to detect a decrease in oxygen levels in the colon, which makes it possible to restore impaired nutrition in real time.

In some studies, the specificity of the method was 90% or higher for acute colonic ischemia and 83% for chronic mesenteric ischemia, with a sensitivity of 71%-92%. However, this device requires endoscopy.

Instrumental diagnostic methods

Usually p abdominal radiography is prescribed initially and is carried out in most cases when acute abdominal diseases are suspected. Initial radiological findings may be normal in cases of colonic ischemia, despite this, the procedure is often performed to differentiate acute pathologies of the abdominal cavity.

Barium stain results are abnormal in 90% of patients with ischemic colitis.

CT scan- the only study after a simple x-ray that allows you to exclude many other causes of abdominal pain. These CT scans can help establish the diagnosis of intestinal ischemia. For symptomatic patients, a CT scan of the abdomen with oral contrast and laboratory testing is performed.

Endoscopic assessment, through colonoscopy or flexible sigmoidoscopy, is a selection procedure. Used in cases where the diagnosis remains unclear. Ischemic colitis has a characteristic endoscopic appearance, and this diagnostic method can also clarify alternative diagnoses, such as infectious or inflammatory bowel diseases.

Video Endoscopic Spectrum of Ischemic Colitis

MRI mainly used in conjunction with magnetic resonance angiography, especially in persons with impaired renal function.

Ultrasonography is a non-invasive method that can provide useful information, especially during the study of chronic mesenteric ischemia.

Angiography has a limited role in cases of ischemic colitis, however, it may be invaluable in some cases associated with the identification of arteriovenous fistulas and steel syndrome.

Treatment

Except in the most severe cases, ischemic colitis is treated with supportive care.

Intravenous infusion is given to treat dehydration
The patient must follow a strict diet until the symptoms disappear.
If necessary, the improvement of oxygen delivery to the ischemic intestine is optimized, for which drugs that enhance the functioning of the heart and lungs are used.
A nasogastric tube may be inserted if there is an intestinal obstruction.
For moderate to severe IR, antibiotics are given. The use of antibiotics for prophylactic purposes has not been proven in prospective studies.

During treatment of ischemic colitis, you should avoid medications that promote spasm of blood vessels. These may include migraine medications, some heart medications, and hormonal medications.

Surgical intervention may be required if the patient has been diagnosed for a long time:

fever;
increased abdominal pain;
high level of white blood cells;
progressive bleeding.

In such cases, surgery usually consists of laparotomy and bowel resection.

The chance of surgery may be higher if the patient has another medical condition, such as heart failure or low blood pressure.

Prevention

Because the cause of ischemic colitis is not always fully understood, there is no certain way to prevent the disorder. Most people with ischemic colitis recover quickly and may never have the disease again.

To prevent recurrent episodes of ischemic colitis, your doctor may recommend eliminating any medications that may cause ischemic colitis. Testing may also be done to determine if there is a clotting disorder, especially if no other cause of ischemic colitis has been found.

Forecast

Most patients with ischemic colitis make a full recovery, although the prognosis depends on the severity of the intestinal damage. Patients with pre-existing peripheral vascular disease or ischemia of the ascending (right) colon may be at increased risk of complications or death.

Non-gangrenous ischemic colitis, which is diagnosed in most cases, is associated with mortality in approximately 6% of cases. However, in the smaller number of patients who develop gangrene as a result of colonic ischemia, the mortality rate is 50-75% with surgical treatment. If surgical treatment is not performed, then the risk of death reaches almost 100%.

Long-term complications

About 20% of patients with acute ischemic colitis may subsequently develop chronic ischemic colitis. Symptoms of this disease include recurrent infections, bloody diarrhea, weight loss and chronic abdominal pain. Chronic ischemic colitis is mainly treated by surgical removal of the diseased part of the intestine.

Colon stenosis is a disease caused by the proliferation of scar tissue that forms as a result of ischemic injury. It narrows the lumen of the colon by forming strictures and worsens the patient's condition. Strictures often resolve spontaneously within 12 to 24 months. If bowel obstruction occurs due to strictures, surgical resection is most often performed, although gentler methods such as endoscopic dilatation and stenting have also begun to be practiced.

Video 10 Diet For Ischemic Colitis

Ischemic colitis is a segmental lesion of the colon associated with a violation of its blood supply. The area of the splenic curvature suffers to a greater extent from this, less often the sigmoid and transverse colon descending colon.

Etiology and pathogenesis: occurs more often in elderly people diagnosed with atherosclerosis. Such colitis causes atherosclerotic lesions in the inferior mesenteric artery; The prerequisites for such a disease is the anatomical feature of this artery branching off at an acute angle from the aorta.

external compression of blood vessels, accompanied by a tumor, enlarged lymph nodes, and adhesions;
atherosclerosis of the mesenteric artery (upper, lower);
abnormal vascular development;
infective endocarditis;
microspherocytic anemia;
complex fibromuscular dysplasia;
rheumatoid arthritis, i.e. systemic connective tissue diseases;
systemic vasculitis, such as nodular panarteritis, Buerger's obliterating thrombanitis, nonspecific aortoarteritis.

Symptoms, course of ischemic colitis

Gangrene (gangrenous form) occurs if the inferior mesenteric artery is completely blocked.

Signs of the disease: attacks of sharp pain begin in the left half of the abdomen, rectal bleeding, signs of intestinal obstruction, and then peritonitis.

“Intermittent intestinal claudication” is a passing episodic form, detected when this artery is partially blocked; manifests itself in the form of epigastria, increasing pain in the left half of the abdomen, occurring immediately after eating, bloating, diarrhea, and sometimes vomiting. In this case, weight loss may develop. When palpating the abdomen, there is a painful sensation at the location of the affected area of the colon, and sometimes, in the anterior abdominal wall - muscle tension.

The diagnosis is confirmed by examining sigmoidoscopy, irrigation and colonoscopy. Examination through irrigoscopy in the affected area allows us to detect a picture of a “pseudotumor” with a “thumb print” - a filling defect. An endoscopic examination reveals submucosal hemorrhages, ulcerations and, due to scarring of ulcers, stricture of the affected area of the intestine; in the affected area, swelling of the mucous membrane; in chronic cases, inflammation of the infiltration of the mucous membrane. Selective mesenteric angiography confirms the obstruction of the mesenteric artery.

The characteristics of the disease are such that the course of the chronic form progresses, the prognosis is usually unfavorable. Possible complications: necrosis of a section of the intestine with developing peritonitis, acute intestinal profuse bleeding, due to inflammatory-scarring processes in the intestinal wall - gradual narrowing of the affected segment.

Treatment of ischemic colitis

Patients with the gangrenous form of ischemic colitis are subject to urgent hospitalization in a surgical hospital. Structural and gangrenous forms require surgical intervention and subsequent treatment.

Such a disease in its chronic form can be treated with antispasmodic and anticholinergic drugs.

For diarrhea, antidiarrheals are prescribed, and for constipation, laxatives are prescribed. To improve intestinal microcirculation, vascular agents are prescribed. The patient also begins taking B vitamins and ascorbic acid, and if iron deficiency anemia occurs, iron supplements. Severe pain is relieved with analgesics, the use of which must be strictly dosed.

Nutrition for ischemic colitis

When ischemic colitis occurs, especially in its early stages, a diet is prescribed according to the prevailing intestinal disorders.

For constipation, the diet is based on foods rich in fiber; for diarrhea, limit the consumption of foods that cause fermentation: milk, peas, cabbage, cucumbers.

With ischemic colitis, it is necessary to eat frequently and in small portions (at least 5 times a day).

Doctors prescribe diet No. 4 according to Pevzner. As the inflammatory process decreases, the diet is adjusted. To restore the intestinal microflora, prebiotics and probiotics, vitamins C, B2, B6, B12, and mineral waters are prescribed.

Be sure to exclude:

spices,
spicy dishes,
products that enhance fermentation (cabbage, sour varieties of fruits and berries, fresh and rich bakery products),
products with coarse fiber (turnips, radishes, onions, garlic, radishes)
fatty, smoked, marinated dishes

In case of exacerbations of colitis and diarrhea, minimize lactic acid products.

Fruits can be consumed in the form of purees, juices, jelly, baked (apples), in their natural form - only during remission and only those that do not increase fermentation and do not have a laxative effect, i.e. It is better to exclude grapes, prunes, and figs from the diet.

You should also minimize your salt intake.

Video - first aid for heart pain

Ischemic colitis– chronic disease of the large intestine. It occurs due to disturbances in blood flow in its walls. In severe cases, intoxication occurs. Treatment depends on the form of the disease; surgery may be used.

The disease occurs in old age, usually in women. Ischemic colitis causes severe inflammation of the large intestine. The blood supply is responsible for the arteries at the top and bottom. The superior artery is responsible for the blood supply to the cecum and small intestine, the lower is responsible for the blood flow to the left side of the large intestine.

The disease leads to the development of dysbiosis and decreased immunity in the intestines. In this case, the splenic flexure is affected, symptoms appear in varying degrees of complexity.

Causes of the disease

Determining the true cause of ischemic colitis is very difficult. There are a large number of factors that cause this disease. The main ones include:

vascular spasms;
occlusion;
decrease in blood pressure.

Occlusion occurs against the background of atherosclerosis, herbs, complications after surgery, and allergic reactions. If blood pressure drops sharply with this disease, this can cause acute allergies, severe anemia, and dehydration.

In severe cases, necrosis and gangrene develop against the background of occlusion, which depends on the area of intestinal damage. The colon has a very poor blood supply due to its anatomy. Heart failure, trauma, and shock further aggravate this process.

Forms of ischemic colitis

There are two forms of ischemic colitis: acute and chronic. Acute can cause infarction of the intestinal mucosa. Necrosis of the tissues of this organ occurs. Distributes inside the walls.

The chronic form is accompanied by severe abdominal pain, stool disorders, nausea, vomiting, disrupted intestinal structure and pathological changes.

There are three clinical forms of the disease:

Transitional. In this case, blood circulation is rarely disrupted, but an inflammatory process develops.
Stenosing (pseudotumorous). Blood supply disruption occurs regularly. The inflammation worsens, scarring appears on the walls of the large intestine.
Gangrenous. The most severe and life-threatening form of ischemic colitis. All layers of the intestinal walls are affected. This causes severe complications that develop rapidly.

Before starting treatment, it is important to determine the form of ischemic colitis. To do this, the patient needs to undergo diagnostics.

Clinical picture

The manifestation of symptoms depends on the disruption of blood flow in the large intestine. If a large area is affected, then the signs will appear brightly and often. The following symptoms indicate the development of the disease:

Severe abdominal pain localized in the affected area. It can occur on the right or left side. Pain is felt in the neck, back and even in the back of the head. The pain can be periodic and occur in the form of attacks. Characterized by a dull pain, which can intensify with strong physical stress and constipation.

The affected person suffers from constipation and diarrhea. Stool disorders cause the following symptoms:

severe weakness;
weight loss;
frequent headache;
chills, body aches;
temperature increase.

If pain in the abdominal cavity occurs, a visit to a gastroenterologist is recommended. The patient undergoes a comprehensive examination. You cannot endure the pain in this case and put off visiting a doctor. The chronic stage is difficult to treat.

Diagnostics

If ischemic colitis is suspected, a person consults a surgeon or gastroenterologist. The doctor takes into account the patient’s complaints, collects anamnesis, and tries to diagnose the disease based on characteristic signs. Instrumental and laboratory tests will help confirm the diagnosis:

General analysis of blood, urine, feces.
coagulogram;

histology;
blood serum analysis;
enzyme immunoassay blood test;

radiography;
colonoscopy;
endoscopy;

angiographic studies.

The results of these studies help diagnose ischemic colitis and determine the stage of its development. During the examination, the following diseases may be detected in the patient: helminthiasis, dysentery, ulcerative colitis, tumors. They also cause signs of intoxication.

Treatment methods

Treatment is prescribed in combination with diet and bed rest. Especially if ischemic colitis manifests itself in acute form. It is important to start drug therapy at the first manifestations of the disease, this will help prevent the development of a chronic swarm.

Drug therapy consists of antispasmodics and drugs to improve blood circulation in the large intestine. During an exacerbation, the doctor may prescribe a short course of antibiotic treatment. It usually lasts 5-7 days, after which the patient must take bacteria for a long time.

If you have hypertension, you cannot sharply reduce your blood pressure. This can have a negative impact on the development of ischemic colitis and accelerate its development. Medicines are prescribed on an individual basis, taking into account the characteristics of each patient’s body.

If conservative treatment methods do not bring the desired result, surgical intervention is required. Especially in the development of the gangrenous form. The patient is hospitalized and surgery is performed. The rehabilitation period lasts a long time, the patient constantly takes medications.

The intestines are responsible for the state of the immune system, therefore, after drug therapy, a person is prescribed complex vitamins and drugs to stimulate the immune system.

Diet

For the use of medications to produce results, the patient must follow a diet. Products that are allowed:

natural juices;
crackers, bread;
low-fat fermented milk products;

vegetable broth soups;
butter, olive, sunflower;
lean meats;

eggs;
boiled or steamed vegetables;
honey, jam.

List of foods that are prohibited:

fresh baked goods;
fatty soups;
canned food;

manufactured products, semi-finished products;
sour fruits, berries;
sweets, chocolate, cocoa;
alcohol.

In ischemic colitis, nutritional adjustments are mandatory. The healing process depends on this. During the period of remission, you also need to follow a diet and eat only high-quality foods.

Drug therapy

In this case, a person may be prescribed the following medications:

vasodilators;
hypoglycemic agents (to reduce glucose levels in diabetes mellitus);
medications to improve liver function;
enzymes.

The doctor determines the treatment regimen individually. Dietary restrictions apply to every patient. You cannot self-medicate or take it without the advice of a specialist.

It is worth noting that the disease can cause complications. These include:

intestinal obstruction (in severe cases requires surgical intervention);
perforation of the intestinal walls;
wall expansion and necrosis;
bleeding.

If such signs develop, you should consult a doctor. In some cases, drug therapy is sufficient, but in more complex cases, surgery may be necessary.

In addition to diet, the doctor prescribes recommendations for each patient for ischemic colitis for a quick recovery:

Physical activity is prohibited.
You should not lean forward too often or sharply.
Walks in the fresh air (20-30 minutes).
Get adequate sleep, it is useful to sleep at lunchtime (1 hour).
Warm shower.
Comfortable clothes without tight belts.
Treatment in sanatoriums 2 times a year.

It is important to consider that lifestyle, nutrition and emotional state affect the function of the digestive system.

Folk remedies

It is impossible to cure ischemic colitis with traditional medicines. Despite this, some of them are suitable as adjuvant therapy.

Hawthorn. The pharmacy sells ready-made tea with this plant. It is recommended to drink it 2 times a day with the addition of honey. The course of treatment can last up to 3 months.
Melissa. Tea made from this herb has a sedative effect, relieves spasms and helps reduce inflammation. You can drink it 2 times a day, especially useful before bed.

Dog-rose fruit. A decoction is prepared from dried fruits. Take throughout the day before meals.

Traditional medicine should not be the main method of treating ischemic colitis. This serious disease requires drug therapy. During the postoperative period, the patient remains in bed for a long time, so folk remedies are useful as an addition to the main treatment.

How to predict the development of the disease

Ischemic colitis occurs after approximately 60 years of age. Women are at risk due to their anatomy. At this age, various pathologies and diseases develop, which become the cause of the development of new diseases. Elderly people should carefully monitor their diet, medications, and lifestyle.

Very rarely, ischemic colitis occurs in young people, so it is very difficult to predict the development of this disease. With timely diagnosis and dietary nutrition, treatment will be quick and limited to medication.

A disease cannot fail to send signals to a person for a long time. In this case, it all depends on your attitude towards your own health. The initial stage easily turns into acute and chronic. In this case, treatment requires more complex therapy and surgical intervention. Rehabilitation will be long. After this, digestive problems can often occur.

Ischemic colitis is a transient circulatory disorder of the colon.

The blood supply to the large intestine is provided by the superior and inferior mesenteric arteries. The superior mesenteric artery supplies the entire small, cecum, ascending and partially transverse colon; inferior mesenteric artery - left half of the colon.

With ischemia of the large intestine, a significant number of microorganisms populating it contributes to the development of inflammation in the intestinal wall (even transient bacterial invasion is possible). The inflammatory process caused by ischemia of the colon wall further leads to the development of connective tissue in it and even the formation of a fibrous stricture.

The splenic flexure and left parts of the colon are most commonly affected by ischemic colitis.

What causes ischemic colitis?

Necrosis may develop, but usually the process is limited to the mucosa and submucosa and only sometimes affects the entire wall, which requires surgical intervention. It occurs primarily in older adults (over 60 years of age) and the etiology is unknown, although there is some association with the same risk factors as acute mesenteric ischemia.

Symptoms of ischemic colitis

Symptoms of ischemic colitis are less severe and develop more slowly than with acute mesenteric ischemia, and include pain in the left lower quadrant of the abdomen, accompanied by bleeding from the rectum.

Stomach ache. Pain in the abdomen appears 15-20 minutes after eating (especially a large meal) and lasts from 1 to 3 hours. The intensity of the pain varies, and is often quite severe. As the disease progresses and fibrous strictures of the colon develop, the pain becomes constant.

The most common localization of pain is the left iliac region, the projection of the splenic flexure of the transverse colon, less often the epigastric or periumbilical region.

Dyspeptic disorders. Almost 50% of patients experience decreased appetite, nausea, bloating, and sometimes belching of air and food.
Stool disorders. They are observed almost constantly and are manifested by constipation or diarrhea, alternating with constipation. During an exacerbation, diarrhea is more common.
Weight loss for patients. A decrease in body weight in patients with ischemic colitis is observed quite naturally. This is explained by limiting the amount of food and the frequency of its intake (due to increased pain after eating) and a violation of the absorption function of the intestine (quite often, along with ischemia of the colon, there is a deterioration in blood circulation in the small intestine).
Intestinal bleeding. Observed in 80% of patients. The intensity of bleeding varies - from the admixture of blood in the stool to the release of significant amounts of blood from the rectum. Bleeding is caused by erosive and ulcerative changes in the mucous membrane of the colon.
Objective abdominal syndrome. Exacerbation of ischemic colitis is characterized by mild signs of irritation of the peritoneum, tension of the abdominal muscles. On palpation of the abdomen, diffuse sensitivity is noted, as well as pain mainly in the left iliac region or the left half of the abdomen.

Symptoms of severe irritation of the peritoneum, especially those that persist for several hours, make one think about transmural necrosis of the intestine.

Diagnosis of ischemic colitis

Diagnosis is made by colonoscopy; angiography is not indicated.

Laboratory and instrumental data

Complete blood count: characterized by pronounced leukocytosis, a shift in the leukocyte formula to the left, an increase in ESR. With repeated intestinal bleeding, anemia develops.
Urinalysis: no significant changes.
Stool analysis: a large number of red blood cells, white blood cells, and intestinal epithelial cells are found in the stool.
Biochemical blood test: decrease in the content of total protein, albumin (with a long course of the disease), iron, sometimes sodium, potassium, calcium.

Colonoscopy: performed strictly according to indications and only after acute symptoms have subsided. The following changes are revealed: nodular areas of edematous mucous membrane of a blue-purple color, hemorrhagic lesions of the mucous membrane and submucosal layer, ulcerative defects (in the form of points, longitudinal, serpentine), strictures are often found, mainly in the area of the splenic flexure of the transverse colon.

Microscopic examination of colon biopsies reveals edema and thickening, fibrosis of the submucosal layer, its infiltration with lymphocytes, plasma cells, and granulation tissue in the area of the bottom of the ulcers. A characteristic microscopic sign of ischemic colitis is the presence of multiple hemosiderin-containing macrophages.

Survey radiography of the abdominal cavity: an increased amount of air is determined in the splenic angle of the colon or its other parts.
Irrigoscopy: performed only after relief of acute manifestations of the disease. At the level of the lesion, narrowing of the colon is determined, above and below - expansion of the intestine; haustra poorly expressed; sometimes nodular, polyp-like thickenings of the mucous membrane and ulcerations are visible. In marginal areas of the intestine, finger-like imprints (the “thumbprint” symptom) are detected, caused by swelling of the mucous membrane; jaggedness and unevenness of the mucous membrane.
Angiography and Doppler ultrasonography: a decrease in the lumen of the mesenteric arteries is detected.
Parietal pH-metry of the colon using a catheter with a balloon: allows you to compare tissue pH before and after meals. A sign of tissue ischemia is intramural acidosis.

The following circumstances help in diagnosing ischemic colitis:

age over 60-65 years;
the presence of coronary artery disease, arterial hypertension, diabetes mellitus, obliterating atherosclerosis of peripheral arteries (these diseases significantly increase the risk of developing ischemic colitis);
episodes of acute abdominal pain followed by intestinal bleeding;
the corresponding endoscopic picture of the condition of the colon mucosa and the results of histological examination of colon biopsies;