Treatment of ischemic colitis. Methods of treatment of ischemic colitis of the intestine

The large intestine is supplied with blood by the mesenteric arteries, the upper of which supplies blood to the thin, ascending, blind and partially transverse colon, and the lower to the left large intestine. When ischemia of the colonic structures occurs, most of the microorganisms that populate them provoke the development inflammatory process in the intestinal wall, up to bacterial transient invasion.

Against the background of inflammation caused by ischemia, connective tissue and even fibrous structures are formed. Pathology is most typical for elderly patients. According to statistics, in patients with colitis after the age of 50, in more than 75% of cases, it is the ischemic form of pathology that is diagnosed.

Definition

Ischemic colitis is called either inflammation of the colonic tissues that occurs against the background of impaired blood supply to the intestinal walls. Such disorders occur due to narrowing or occlusion of the vascular passages, as a result of which an inflammatory process develops, stricture, and then.

The affected area of ​​the intestine receives less blood supply, which leads to its dysfunctional disorders. Pathology occurs equally often in patients of both sexes. Although the pathology is typical for older patients, it can still affect able-bodied patients.

Causes of pathology

Intestinal inflammation of the ischemic form refers to rather complex pathological conditions and is provoked by many factors.

The most common causes of ischemic colitis are:

• , in which the vascular tissues located in the intestinal structures become inflamed;
• Hypoperfusion - with the progression of this pathology, the intestinal blood supply decreases, which further leads to ischemic lesions of certain areas;
• DIC;
• aortic dissection;
• Anemia;
• in which fat deposits accumulate on the walls;
• , in which blood clots block the vascular lumen, which leads to ischemia;
• liver transplant;
• idiopathic form;
• Some species drug therapy such as hormone therapy.

There are many causes of ischemic inflammation of the intestine, but all of them are associated with vascular spasms. The large intestine is poorly supplied with blood, and against the background shock states, large blood loss, myocardial insufficiency or dehydration on the background intestinal infections leads to the rapid development of ischemia.

Forms

Like many other pathologies, ischemic colitis can occur in a chronic or acute form. In addition, acute colitis can occur:

1. With the progression of an intramural-type infarction, when the necrotic focus has an intramural localization;
2. With a predominance of infarction of the intestinal mucosa, in which necrosis occurs against the background of circulatory disorders;
3. With a progressive infarction of the transmural type, as a result of which the intestinal lesion is of a large-scale nature.

Depending on the clinical form pathology of ischemic colitis can be:

• Stenosing or pseudotumorous, in which blood flow disturbances are permanent, while inflammation progresses rapidly, causing scarring of the intestinal walls;
• Transient, in which vascular blood flow may not be disturbed, but pathological processes still lead to the development of inflammation, which disappears over time;
• Gangrenous is the most dangerous and severe form of colitis, in which the lesion affects all intestinal layers. This form often leads to the development of serious complications.

Symptoms of ischemic colitis

Characteristic manifestations of colitis of the intestinal form are bouts of vomiting and diarrhea, bloating and frequent cramp-like pain in the abdomen.

Patients are concerned about headaches or bleeding, dizziness and hyper sweating, insomnia. In patients against the background of ischemic inflammation of the intestine, there is a noticeable weight loss due to digestive disorders.

by the most hallmark similar colitis is severe pain in the abdomen, which can disturb for two to three hours. Usually, pain is localized on the left side, although the specific location of the pain depends on the lesion.

The pain syndrome is characterized by different characters, it can be paroxysmal or prolonged and aching. To avoid the occurrence of such pain attacks, it is necessary to follow a dietary diet, giving up spicy, excessively hot or cold dishes, as well as dairy products.

In particularly difficult cases, blockage of the mesenteric artery occurs, which leads to the development of gangrene.

A similar complication is indicated by the appearance of an acute pain attack in the abdomen on the left, intestinal obstruction, peritonitis, and.

When there is muscle tension and severe pain. If the patient has cardiovascular pathologies, a gangrenous complication can provoke the death of the patient. That's why importance It has timely diagnosis, which will help prevent gangrenous complication.

Diagnostics

To accurately determine the diagnosis and prescribe to the patient effective treatment requires careful diagnosis.

A complete analysis of the patient's complaints is carried out, and a picture of the pathology is compiled according to the symptoms. The doctor assesses the general condition of the patient, measures the temperature, pressure indicators.

Laboratory blood tests are prescribed, the degree of its coagulability is determined, the lipid component is detected, etc. A stool study is also carried out in order to identify bloody impurities that indicate serious damage to the digestive system.

Endoscopy and X-ray examinations are also carried out. It is important to conduct an electrocardiogram for the patient in order to assess the performance of the cardiac structures. A colonoscopy is also performed, and it helps to identify the exact nature of the pathology and prescribe the correct therapy.

Treatment

Against the background of ischemic inflammation of the intestine, patients, as a rule, develop myocardial insufficiency, which occurs due to spastic contractions and impaired patency of the intestinal walls. The therapy is complex:

• Prescribed drugs from the group of vasodilators;
• Reception of streptocides is shown;
• In order to enrich the blood with oxygen nutrition, oxygen intake is indicated;
• To eliminate the inflammatory process, NSAIDs are indicated;
• Abundant blood loss requires a blood transfusion;
• To restore the water-electrolyte balance in the intestinal tissues, detoxification treatment is indicated.

The intestines affected by inflammatory processes need rest, so patients take nutrition through the parenteral route. If a bacterial infection joins the inflammatory process, then mandatory antibiotic therapy with penicillin preparations is indicated.

With the development of gangrene or necrosis, peritonitis or perforation, emergency surgery is indicated.

Additional vitamin therapy (vitamins B and C), iron-containing drugs are also indicated, and analgesics are needed to relieve pain symptoms.

The diet of the patient requires special attention. In the initial stages of the pathological process, it is recommended to eat foods containing fiber.

If the condition worsens severe diarrhea, then it is recommended to exclude milk and cucumbers, peas and cabbage. If the patient is concerned about constipation, then it is necessary to introduce products that relax the stool into the diet, as well as take vascular and laxative drugs to normalize intestinal motility and restore microcirculation processes.

Ischemic inflammation of the intestine requires etiotropic therapy. If the pathology is accompanied by infectious lesions, then it is necessary to prevent the development of dehydration, so patients need to take Oralit, Regidron and adsorbents like white clay or activated charcoal.

Reception is shown if necessary cardiovascular drugs. Signs of hyperthermia require antibiotics. With the rapid development clinical picture colitis drug therapy may be useless. In such a case, surgical removal of the affected areas of the intestine is prescribed.

Complications

If the patient does not seek help from specialists and starts the pathological process, then complications cannot be avoided.

Most often they are associated with rectal bleeding or intestinal obstruction, peritonitis or perforation of the intestinal walls.

The prognosis of the pathology depends entirely on the degree of development of complications and the stage of development of the inflammatory process in the intestine.

In the absence of necrosis and full restoration of blood flow, the prognostic picture is favorable and the pathology can be completely cured.

But if ischemic colitis is accompanied by extensive necrotic lesions, and the pathology has developed to an advanced stage or is complicated by atherosclerosis or myocardial insufficiency, then it is necessary surgery, which is difficult to predict. In such a situation, the rehabilitation of the patient will be crucial.

Prevention

If the patient is at risk of developing ischemic inflammatory bowel disease, then it is necessary to exclude all factors that provoke the development of pathology.

An integral part of prevention is a therapeutic diet, which involves limiting fried and spicy, fatty foods. Instead of animal fats, it is better to use vegetable fats. Under the ban alcohol, coffee, ice cream and mustard, various pickled preparations, fatty meat, muffins and eggs.

Colitis of the ischemic type often occurs against the background of atherosclerotic lesions, myocardial insufficiency, surgical operations on the intestines, pelvic organs or stomach, so prevention requires competent treatment of primary pathologies. You also need to dose physical activity, undergo annual medical examinations and carry out immuno-strengthening measures.

Caused by inadequate blood supply, is the most common manifestation of intestinal ischemia (60%). The severity depends on the location and prevalence, the severity of the onset of the disease, the presence of collaterals and the level of vascular occlusion: the most vulnerable are the splenic flexure, rectosigmoid junction and the right colon. Many different etiological factors lead to common pathological changes:

Vascular occlusion:
- Occlusion of large vessels: infrarenal aortic shunt, SMA thrombosis/embolism, portal vein thrombosis/SMA, trauma, acute pancreatitis, aortic dissection.
- Peripheral vascular occlusion: diabetic angiopathy, thrombosis, embolism, vasculitis, amyloidosis, rheumatoid arthritis, radiation damage, trauma, embolization during interventional radiological manipulations (with bleeding from the lower gastrointestinal tract), hypercoagulable state (deficiency of proteins C and S, antithrombin III, sickle cell anemia).

Non-occlusive diseases:
- Shock, sepsis, decreased perfusion (eg, atrial fibrillation, myocardial infarction, heart-lung machine), steal phenomenon, increased intra-abdominal pressure syndrome.
- Colon obstruction, intussusception, hernia.
- Intoxication: cocaine, drugs (NSAIDs, vasopressors, digoxin, diuretics, chemotherapy drugs, gold compounds).

Attention: Patients may have other significant pathological changes (eg, cancer) in affected or unaffected areas.

Treatment varies from conservative management (mild and moderate forms) to segmental resections and even colectomy (severe or life-threatening forms).

a) Epidemiology of ischemic colitis:
The peak incidence occurs between 60 and 90 years of age. Women are affected more often than men. Cause of emergency hospitalization in 1 in 2000 cases.
The true incidence is unknown due to misdiagnosis. Previously, up to 10% of ischemic colitis was caused by prosthetics of the infrarenal aorta, less often by interventional manipulations under X-ray control.
Localization: 80% - in the left sections (between the splenic flexure and sigmoid colon), 10-20% - in the descending or transverse colon,<3% - в прямой кишке.

b) Symptoms of ischemic colitis

Acute ischemia:
Initial stage: acute ischemia => acute onset of abdominal pain, possibly spastic, hyperperistalsis, may be accompanied by diarrhea and urge to defecate.
Second stage: beginning tissue necrosis (after 12-24 hours) => paresis, paradoxical decrease in pain, bleeding (unchanged blood in the stool), mild peritoneal symptoms.
Third stage: peritonitis, sepsis - increased peritoneal symptoms, signs of intoxication (fever, leukocytosis with a shift to the left, tachycardia); complete paresis, nausea, vomiting, unstable hemodynamics, septic shock.
Complications:
- Dilatation of the colon and changes in the wall => perforation, sepsis, oliguria, multiple organ failure, death.
- Sepsis -> bacterial colonization of implants placed due to ischemia (e.g. prosthetic valves, aortic prostheses, etc.)

Chronic ischemia:
Angina abdominalis ("abdominal toad"): pain after eating as a result of insufficient blood flow to the intestines.
Strictures due to ischemic colitis => symptoms of obstruction.

in) Differential Diagnosis ischemic colitis:
- VZK: ulcerative colitis, .
- Infectious colitis: Shigella, enterohemorrhagic E.coli, Salmonella, Campylobacter, etc.
- Colorectal cancer.
- Diverticulosis, diverticulitis.
- Radiation proctitis.
- Other causes of acute abdominal pain and / or bleeding from the lower gastrointestinal tract.

G) Pathomorphology
Macroscopic examination:
Acute ischemia: swelling of the entire wall or only of the intestinal mucosa => area of ​​ulceration and necrosis, segmental full-walled necrosis => segmental gangrene.
Chronic ischemia: fibrous stricture, the mucosal surface is intact.

microscopic examination:
Acute ischemia: superficial mucosal necrosis (crypts are initially intact) => hemorrhages and pseudomembranes => transmural necrosis (loss of nuclei, cell shadows, inflammatory response, disruption of cellular architectonics); possible presence of visible blood clots, emboli, cholesterol emboli.
Chronic ischemia: mostly intact mucosa, but there is atrophy of the crypts and focal erosions, thickening/hyalinosis of the lamina propria, diffuse fibrosis.

e) Examination for ischemic colitis

Required minimum standard:
Anamnesis:
- Recent vascular surgery, embolism, "abdominal toad", a history of vasculitis, taking medications (including warfarin, acetylsalicylic acid).
- Triad of symptoms: acute abdominal pain, blood from the rectum, diarrhea.

Clinical examination:
- The main indicators of the state of the body: arrhythmia (atrial fibrillation), the stability of hemodynamic parameters?
- Bloating, abdominal pain abdominal cavity, inconsistent with the data of the clinical examination, hyperperistalsis or paresis, peritoneal symptoms?
- Preservation of the pulse on femoral arteries and distal vessels of the extremities? Signs of widespread atherosclerosis?

Laboratory tests : blood => leukocytosis, anemia, thrombocytopenia (?), lactic acidosis, creatine kinase-BB, hypophosphatemia, coagulopathy, hypoproteinemia?

Radiation Imaging Methods:
- Abdominal/thoracic x-ray: free gas, "finger impression" sign, loss of haustration, dilated loops.
- CT with oral/IV contrast if available (kidney function!): most practical if pain is primary symptom=> free gas in the abdominal cavity, segmental thickening of the intestinal wall, a symptom of “digital depressions”, pneumatosis, loss of haustration, widening of the loops, a symptom of a “double halo”, gas in the portal vein? Other causes of abdominal pain? The state of the main ways of vascular outflow: blood clots?

Colonoscopy- "gold" standard: the most sensitive method, contraindicated in the presence of peritoneal symptoms: normal rectum (in the absence of complete occlusion of the aorta); segmental changes in the mucosa => hemorrhages, necrosis, ulcers, vulnerability? Strictures?

Additional studies (optional):
X-ray contrast studies are usually not indicated in an acute situation (usual signs: a symptom of "finger impressions", edema of the intestinal wall, loss of haustration, ulcers); chronic ischemia => bowel shape, stricture?
Visceral angiography (interventional, eg, thrombolysis): relatively limited role in the acute setting, except in cases of possible successful thrombolysis; assessment of symptoms of chronic ischemia -» vascular architectonics.

e) Classification of ischemic colitis
- Based on etiological factors: occlusive/non-occlusive ischemia.

Based on pathological changes:
Gangrenous ischemic colitis (15-20%).
Non-gangrenous ischemic colitis (80-85%):
- Transient, reversible (60-70%).
- Chronic irreversible => chronic segmental colitis (20-25%) => stricture (10-15%).

and) Treatment without surgery for ischemic colitis:
Recovery of hemodynamic parameters: replenishment of volume more important than application vasopressors.
Broad Spectrum Antibiotics Series clinical research with periods of "rest" for the colon.
Heparinization, if tolerated.
Possibly interventional radiology.
Repeat colonoscopies: monitor the effectiveness of treatment, re-examination of the colon under optimal conditions to detect other pathological changes.

h) Surgery for ischemic colitis:

Indications:
Acute ischemia: peritonitis, pain inconsistent with clinical examination data, signs of gangrene, sepsis refractory to treatment, pneumoperitoneum; no improvement, persistent protein loss due to pathological changes intestines (lasting > 14 days).
Chronic ischemia: recurrent sepsis, symptomatic colonic stricture, any stricture in which the presence of a tumor cannot be ruled out.

Surgical approach:
1. Acute ischemia:
Resection of the affected segment => intraoperative assessment of the viability of the colon: bleeding from the edges of the mucosa, venous thrombi, the presence of a palpable pulse?
- Primary anastomosis or stoma (for example, double-barreled).
- Controversial viability: planned relaparotomy or more extensive resection.
Exploratory laparotomy if the area of ​​necrosis is too large and incommensurable with life.

2. Chronic ischemia:
Resection of the affected segment with the formation of a primary anastomosis.
Vascular interventions and subsequent reconstruction are possible.

and) Results of treatment of ischemic colitis:
Transient ischemia: relatively good prognosis, largely dependent on prognosis in other organs; 50% of cases are reversible, clinical resolution within 48-72 hours, resolution of the endoscopic picture within 2 weeks; at more severe forms healing is long (up to 6 months) => stricture?
Gangrenous ischemia: lethality in 50-60% of cases - the population of patients with concomitant diseases and with the most severe course of the disease!
Chronic ischemia: morbidity and mortality are similar to those of colon resection for other diseases, but there is a higher risk of cardiovascular complications.

to) Observation and further treatment:
Full examination of the intestine after 6 weeks (if the condition allows).
Emergency surgery: planning further interventions, i.e. restoration of intestinal continuity in a planned manner, after complete recovery physical condition and nutrition.
Determination of the variant and duration of anticoagulant therapy.

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

Causes

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

Also to the reasons for the development this disease include the following events:

• Spasms of blood vessels due to atherosclerosis. An increase in the amount of fat on the walls of blood vessels;
• Decreased blood pressure;
• Thrombus formation ( blood clots) in vessels;
• Dissection or damage to the aorta. 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;
• The formation of a tumor in the intestine and its obstruction;
• Sickle cell anemia. Violation of the structure of the hemoglobin protein. The protein takes on a crescent 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 diagnosing acute ischemic colitis in the human body, the organs of the intestinal mucosa die off.

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

At chronic form diseases, the patient has nausea, gag reflexes after eating, constipation alternates with loose stools, constant sharp pains in a stomach. As a rule, chronic colitis leads to intestinal stricture, there is a deformation of the intestine (its narrowing). And this has a positive effect on the further development intestinal diseases, and can affect the development of intestinal gangrene and the appearance of ulcers.

Symptoms

Typically, patients experience persistent abdominal pain. Depending on the location of the damage to the colon, the focus of pain may be in the left or right side of the abdomen. Sometimes the pain can be girdle. Pain can be in the form of short attacks of 10-15 minutes, or be permanent. 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 cloyingly sweet, spicy, scalding foods, and dairy products can exacerbate pain. Pain may also appear after physical activity. For example, long walks, heavy lifting, prolonged work in an uncomfortable bent position.

Another obvious symptom is loose stools with lots of blood or purulent discharge. On the walls of the rectum appear blood traces, remnants of mucus and pus. The amount of discharge depends on the form and severity of the intestinal lesion. At the initial disease, they may not be in the feces at all, but the smell of rot will already be present. Usually, at the first symptoms, diarrhea is replaced by constipation and vice versa.

Other symptoms that characterize ischemic colitis can also include:

• nausea;
• vomiting;
• Diarrhea;
• Bloating
• Sleep disturbance;
• Rapid fatigue;
• Weakness of the whole organism as a whole;
• Excessive sweating;
• Dizziness and constant headaches.

Diagnostics

As a rule, ischemic colitis is an age-related disease. About 80% of patients with this diagnosis are older than 50 years. To determine the disease, doctors conduct a general examination, pay attention to the patient's complaints and lifestyle. Analyze what could lead to such bowel disease. For example, a patient has undergone surgery or has a tumor. Regular intake of certain medicines, alcohol, spicy food, can cause such abnormalities.

After an external examination, laboratory tests follow:

• General blood analysis. Helps to detect 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 discovery kidney failure and infections of internal organs.
• Fecal analysis. When detecting blood, mucous deposits, purulent discharge, one can accurately state a violation of the digestive system.
• Blood chemistry. A blood test 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 in determining ischemic colitis is instrumental research. These include:

1. Colonoscopy. One of the most effective methods. As a rule, it is carried out in combination with a biopsy. The patient's large intestine is viewed 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 accurate diagnosis.
2. Irrigoscopy. Examination of the intestine using x-rays. This method allows you to fairly accurately determine the degree of damage to the intestine. And also to detect strictures and affected areas.
3. Research using ultrasound. Ultrasound of the abdominal aorta is used to identify affected cells and vessels. Thus, it is possible to detect the formation of fatty deposits on the walls of blood vessels.
4. Doppler study. Helps to determine the condition of the arteries.
5. Laparoscopy. This method includes surgical intervention. The patient is made several small holes in the abdominal cavity. This is necessary to introduce an endoscope - a device for examining internal organs. After examining and assessing the damage, an operating instrument can be inserted through these holes and treated.
6. Electrocardiography. With the help of an ECG, fluctuations in electric fields are recorded, which makes it possible to identify deviations in the work 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. Light laxatives are prescribed. At loose stool using antidiarrheals. Animal fats are replaced with fats plant origin. There is a tendency to reduce and completely abandon spicy, fatty and fried foods. To raise immunity and normalize the functioning of the body as a whole, vitamin complexes are prescribed.

If these methods do not help, doctors conduct antiplatelet therapy aimed at reducing blood viscosity. Prescribed vasodilators, enzymes, phospholipids. These drugs are aimed at normalizing the water-alkaline balance and bowel function in general. In some cases, a blood transfusion may be needed.

Surgical treatment is considered in severe cases, when the diagnosis is made too late and medications unable to fight infection. The affected area is removed, an audit is carried out and a special drainage is placed.

Consequences and complications

Unfortunately, complications after such operations are quite normal. Since the age of patients is quite advanced, 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, difficultly, or does not pass at all, causing flatulence, bloating, nausea and vomiting reflexes.

Sometimes a rupture of the intestinal wall can occur, leading to an infection of the whole body. To negative consequences intestinal colitis, also includes an increase in the size of the large intestine and profuse hemorrhage.

Prevention

For the most part, ischemic colitis occurs with complications of atherosclerosis, during postoperative recovery of internal organs, and serious heart failure. Therefore, prevention is based on effective treatment of these diseases.

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

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

Ischemic colitis is an ailment characterized by ischemia (impaired circulation of blood) of the vessels of the large intestine. As a result of the development of pathology, the affected segment of the intestine does not receive the necessary amount of blood, so its functions are gradually impaired.

Ischemic colitis predominantly affects the elderly. In more rare cases, the pathology affects people of working age.

The reasons

Ischemic colitis is a complex pathology, the progression of which can be triggered by many adverse factors. The most common causes of the disease are the following stalemate. states:

• hypoperfusion. With the progression of this pathology, the blood supply to the intestine is significantly reduced, which in the future leads to ischemia of certain sections of it;
• atherosclerotic vascular disease. - this is a pathology in which a certain amount of lipids (fats) accumulate on the walls of blood vessels, which interferes with normal blood flow;
• . In some forms of these ailments, the vessels located in the intestine can become inflamed;
• . A blood clot can completely or partially block the lumen of an artery or vein, and as a result, ischemia will develop;
• DIC;
• neoplasms of the intestine;
• aortic dissection;
• liver transplant;
• idiopathic colitis (the main cause of the disease is not known);
• the use of certain groups of synthetic drugs. For example, hormonal

Forms

Ischemic colitis according to the nature of the course of the pathological process is:

• sharp;
• chronic.

In turn, acute ischemic colitis is:

• with progression of infarction of the intestinal mucosa. There is necrosis (necrosis) of this organ due to a violation of its blood supply;
• with progression of intramural infarction. The zone of necrosis is localized inside the wall of the large intestine;
• with progression of transmural infarction. As a result of the development of this process, absolutely all intestinal walls are affected.

Chronic ischemic colitis occurs, as a rule, with abdominal pain, nausea and impaired stool. In severe clinical cases, intestinal strictures develop - a pathological narrowing of its specific area.

Clinicians also distinguish three forms of this disease:

• transient. Blood circulation in the vessels is not often disturbed, but against the background of this process, inflammation develops, which disappears over time;
• stenosing, also called pseudotumorous. Circulatory disturbance is permanent. The inflammatory process progresses, resulting in scarring of the intestinal wall;
• gangrenous colitis. This form of the disease is the most severe and dangerous for the health and life of the patient. All layers of the walls are affected. Against this background, complications progress.

Symptoms

The clinic primarily depends on the degree of circulatory disorders in the large intestine. The larger the area affected by ischemia, the more pronounced the symptoms of the disease.

With the progression of the disease, several characteristic symptoms are observed at once:

• severe pain in the abdomen. Its location may vary depending on the place where the affected area itself is localized. The pain can be observed on the right or left, or be girdle. The pain symptom radiates to the neck, occiput, subscapular and interscapular region. It is observed constantly or occurs periodically and paroxysmal (periods of exacerbation alternate with periods of calm). The nature of the pain is pressing and dull. But if you do not pay attention to this symptom in time and do not visit medical institution for diagnosis and treatment, then gradually the pain symptom intensifies and becomes intense, cutting, sharp.

The pain may increase after physical exertion, eating, or due to constipation (a characteristic symptom).

• sweating is increased;
• there is flatulence and bloating;
• sleep disturbance;
• nausea and vomiting;
• belching with an unpleasant odor;
• intestinal bleeding;
• permanent disturbance of the stool. This is manifested by the fact that the patient has diarrhea alternating with constipation. In this case it is a characteristic symptom;
• weakness and fatigue;
• weight loss;
• headache;
• an increase in body temperature is accompanied by chills.

In the presence of one or more of the above symptoms, it is recommended to immediately contact a qualified specialist for diagnosis, confirmation or refutation of the diagnosis. Self-medication in this case is unacceptable, since you can only aggravate your condition and provoke the development of complications.

Diagnostics

First, the doctor analyzes the complaints of the patient himself. The symptoms, their nature and intensity are specified. Next, an anamnesis of the patient's life and the disease itself is collected. To diagnose the disease, laboratory and instrumental techniques are used to accurately diagnose and identify the cause of the pathology.

Laboratory methods:

• stool analysis;
• coagulogram;
• lipid spectrum of blood serum;

Instrumental techniques:

• bicycle ergometric test;
• Doppler study;
• angiographic study;
• x-ray of the intestine;
• laparoscopy.

Treatment

The course of treatment can be prescribed only by a qualified specialist after the diagnosis and evaluation of the results. In many ways, therapy depends on the degree of damage to the intestinal vessels. The standard treatment plan includes:

• appointment of diet number 5. The patient is shown to reduce the consumption of spicy, fried and fatty foods;
• normalization of hyper- and dyslipidemia. In this case, it is necessary to stop the progression of atherosclerosis;
• drugs are prescribed, the main action of which is aimed at reducing blood viscosity;
• vasodilators;
• hypoglycemic drugs;
• nitrates. These substances help to stop the pain syndrome;
• symptomatic therapy. In this case, all activities are aimed at reducing the symptoms of the disease;
• essential phospholipids;
• enzyme preparations;
• if the patient is overweight, then it is necessary to normalize it;
• surgical treatment is indicated in the most difficult clinical situations, and it consists in removing the affected part of the large intestine.

Diet

Diet in the treatment of ischemic colitis plays one of the most important roles. It is prescribed only by a doctor. He can also make the proposed menu.

Approved products:

• jelly, compote, weak tea;
• eggs in the amount of one piece per day;
• wheat or rye bread;
• vegetable oil;
• skim cheese;
• low-fat cheese;
• cereals;
• greens and vegetables;
• soups cooked on vegetable broth;
• you can eat lean meat.

• pickled vegetables;
• products made from rich dough;
• soups on meat or mushroom broths;
• fats and lard;
• fried eggs;
• radishes, green onions and spinach;
• spicy seasonings;
• chocolate;
• alcohol;
• cocoa and black coffee.

Complications

If you do not pay attention to alarming symptoms in time and do not treat the disease, the following complications may develop:

• perforation;
• intestinal obstruction;
• profuse intestinal bleeding.

Preventive actions

In order not to treat ischemic colitis in the future, it is necessary to carry out its prevention in a timely manner. Main preventive actions aimed at eliminating the causes that provoke the progression of pathology:

• adhere to the correct diet (you can, as during treatment, follow diet No. 5);
• moderate physical activity;
• passage preventive examinations for timely detection and treatment of ailments;
• boosting immunity.

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Diseases with similar symptoms:

Jaundice is a pathological process, the formation of which is affected by a high concentration of bilirubin in the blood. The disease can be diagnosed in both adults and children. call like this pathological condition capable of any disease, and they are all completely different.

Ischemic colitis is an inflammatory disease that affects the large intestine and is formed due to segmental circulatory disorders.

The main reason for the appearance of such a disorder is spasm or occlusion of the blood vessels supplying this organ. A large number of diseases and predisposing factors can become sources of such disorders.

The disease does not have specific clinical manifestations, which makes diagnosis much more difficult. The main symptoms include pain, increased gas formation, nausea and belching. Establishing the correct diagnosis involves the implementation of a number of laboratory and instrumental diagnostic measures.

Treatment can be either conservative or surgical. The basis of therapy is the observance of a sparing diet, the appointment of medications and the excision of the affected part of the intestine.

Etiology

The large intestine is included in the group of those internal organs that are rather poorly supplied with blood, and its functional activity leads to an even greater decrease in blood flow. It is for this reason that a wide range of pathologies can lead to the development of ischemia and ischemic colitis.

The main sources of such a disease can be considered:

• heart failure;
• atherosclerotic lesion of blood vessels - with such a disorder, lipids accumulate in the walls of blood vessels;
• the formation of blood clots;
• DIC, which is characterized by a violation of the process of blood clotting;
• hypoperfusion or insufficient blood supply to this organ;
• the course of the inflammatory process in the vessels of the large intestine;
• aortic dissection;
• such hereditary pathology like sickle cell anemia;
• intestinal obstruction;
• transplantation of a donor organ, namely the liver;
• malignant or benign tumors in the intestines;
• severe blood loss due to injuries or surgical interventions;
• loss a large number liquids against the background of infectious processes in the intestine;
• systemic vasculitis;
• allergic reactions.

Ischemic colitis often affects the sigmoid or transverse colon, especially when atherosclerosis is a factor in the appearance of the disease. However, this does not mean at all that the defeat of other departments of this organ is completely excluded.

Classification

According to the nature of the course, the disease is divided into:

• acute ischemic colitis - characterized by the rapid development of symptoms and a significant deterioration in a person's condition. Accompanied by infarction of the mucous or submucosal layer, as well as the entire intestine;
• chronic ischemic colitis - characterized by an undulating course and over time can be complicated by the formation of strictures.

In addition, there are several more forms of the course of the disease:

• transient - is expressed in a periodic violation of blood circulation in the vessels of this organ. Against this background, an inflammatory process develops, which is then independently neutralized;
• stenosing or pseudotumorous - a scarring process occurs due to constant inflammation and circulatory disorders. This leads to a narrowing of the affected organ;
• gangrenous - is considered the most severe type of disease, since all layers of the large intestine are involved in the pathogenic process. In almost all cases, this form leads to the development of complications.

Separately, it is worth highlighting idiopathic ischemic colitis, the causes of which could not be clarified.

Symptoms

Manifestation clinical signs of such an ailment directly depends on the degree of circulatory disorders in the affected organ - the larger the area affected, the more vivid the symptoms will be. Thus, the symptoms of ischemic colitis will be as follows:

• pain syndrome. The place of its localization will correspond to the place of the intestinal lesion. Pain can occur in the left or right side of the abdomen, and is often girdle in nature. There is a spread pain in the lumbar region, shoulder blades, neck and occiput;
• an increase in the size of the abdomen;
• increased gas formation and sweating;
• violation of the stool, which is expressed in the alternation of constipation and diarrhea. AT stool ah there are impurities of blood and mucus;
• weight loss, which occurs against the background of refusal to eat, which, in turn, is caused by the appearance of signs precisely after eating food;
• sleep disturbance - there is drowsiness during the daytime and complete absence sleep at night;
• weakness of the body and fatigue, which reduces human performance;
• bouts of severe headache;
• increase in body temperature;
• pallor of the skin;
• the formation of xanthelasmas and xanthomas - often they are located on the chest, elbows and back;
• intestinal bleeding.

If the above clinical manifestations begin to pass on their own, after which they increase sharply, this indicates that the disease has become irreversible.

Diagnostics

have the highest diagnostic value instrumental methods examination of the patient, however, before their appointment, the clinician must independently perform several manipulations:

• conduct a detailed survey of the patient regarding the severity of symptoms;
• get acquainted with the medical history and anamnesis of the patient's life - to identify what etiological factors preceded the development of the disease;
• perform a thorough physical examination, which includes measuring blood pressure and temperature, as well as palpation of the anterior wall of the peritoneum.

Laboratory studies are aimed at:

• clinical blood test;
• samples for the study of blood clotting;
• lipid spectrum of blood serum;
• general examination of urine;
• microscopic examination of feces - it is possible to detect impurities of blood and mucus.

Instrumental diagnosis of ischemic colitis of the intestine involves the implementation of:

• Ultrasound of the abdominal organs with dopplerography;
• ECG - to control the functioning of the heart;
• functional tests using an exercise bike or treadmill - to study how the patient tolerates physical activity;
• irrigoscopy of the intestine;
• colonoscopy - to evaluate the inner surface of the large intestine;
• biopsy - carried out during the previous procedure and is aimed at taking a small piece of the affected organ for subsequent histological analyzes;
• endoscopic laparoscopy - to examine the abdominal organs.

Differential diagnosis of such an ailment is carried out with:

• various diseases of infectious etiology;
• Crohn's syndrome;
• oncology;
• ulcerative colitis of a nonspecific nature.

Treatment

Elimination of ischemic colitis requires an integrated approach and includes:

• compliance with a sparing diet - dietary table number five is taken as the basis;
• taking medications such as vasodilators, mild laxatives, and antiplatelet agents;
• detoxification therapy - such treatment is necessary for a severe course of the disease;
• normalization of water and electrolyte balance;
• blood transfusion;
• antibiotic therapy.

Surgical intervention is indicated when complications are detected and is aimed at excision of the affected section of the large intestine.

Complications

Untimely treatment quite often leads to the development of such consequences as:

• partial or complete intestinal obstruction;
• rupture of the wall of the affected organ;
• pathological expansion of the affected organ;
• intestinal hemorrhage;
• peritonitis;
• the formation of strictures;
• oncology.

Prevention and prognosis

Due to the fact that ischemic colitis is a complication of many diseases, their timely elimination can be considered the only preventive measure. In addition, it is recommended to adhere to the rules of diet number 5.

The prognosis of the disease is often favorable, but depends on the age of the patient and his general condition, as well as the presence of complications and concomitant ailments.