eMedicine Specialties > Radiology > Gastrointestinal
Colitis, Ischemic: Multimedia
Updated: Sep 1, 2009
Multimedia
 | Media file 1: Arterial blood supply to the large bowel shows the potential site of ischemia. |
 | Media file 2: Double-contrast barium enema study shows a stricture of the proximal descending colon secondary to ischemia. |
 | Media file 3: Erect radiograph obtained after a double-contrast barium enema study shows a stricture at the splenic flexure. |
 | Media file 4: Postevacuation image obtained after a barium enema study shows extensive thumbprinting involving the entire colon, secondary to mesenteric ischemia. |
 | Media file 5: Plain abdominal radiograph in a 65-year-old man presenting with acute abdominal pain and the passage of blood per rectum. Note the thumbprinting in the region of the splenic flexure and also the proximal small-bowel dilatation. |
 | Media file 6: Left: Plain abdominal radiograph in a 58-year-old man who underwent an upper GI barium study for nonspecific dyspepsia a few days earlier. The patient presented with vague abdominal discomfort and the passage of blood per rectum. Note the thumbprinting in the region of the distal transverse colon and splenic flexure. Right: Another radiograph obtained 24 hours later shows mild dilatation of the distal transverse colon with more obvious mucosal edema. |
 | Media file 7: Six days later, the clinical condition of the patient seen in Image above deteriorated, with increasing abdominal pain and signs of peritonism. Note the bowel relief sign. At surgery, a perforated ischemic bowel segment at the splenic flexure was confirmed. |
 | Media file 8: Left: Chest radiograph of a 45-year-old woman with mitral valve disease and atrial fibrillation who presented with acute abdominal symptoms. Note the cardiomegaly and blood diversion in the upper lobe, which is suggestive of cardiac decompensation. Right: Plain radiograph shows several dilated loops of the jejunum. Note also the stricture of the proximal transverse colon. At surgery, a gangrenous small bowel loop secondary to a mesenteric artery embolus was resected. The patient had a similar episode a year earlier, which was managed conservatively; this approach accounts for the ischemic stricture of the proximal transverse colon. |
 | Media file 9: Digital subtracted superior mesenteric angiogram in a 63-year-old woman known to have a hilar cholangiocarcinoma (note the biliary stent) who presented with a sudden onset of abdominal pain and distension. This frame from the angiogram shows a sharp cut-off of the superior mesenteric artery secondary to an acute thrombosis. This patient underwent thrombolysis, with a satisfactory outcome. |
 | Media file 10: This 63-year-old man had smoked more than 30 cigarettes a day for over 40 years and gave a 3-year history of claudication. Recently, he presented with the passage of mucus and blood per rectum. Flexible sigmoidoscopy revealed a hemorrhagic edematous mucosa with superficial ulceration at the rectosigmoid junction suggestive of ischemic colitis. A flush aortogram showed only the origin of the superior mesenteric artery, but the celiac artery and the inferior artery origins were not identified. A selective superior mesenteric artery angiogram shows retrograde filling of the celiac axis and antegrade filling of the inferior mesenteric artery. Note the arch of Riolan. The image on the right is a manual subtraction image of the angiogram on the left. |
 | Media file 11: Normal inferior mesenteric angiogram in a 53-year-old man. |
 | Media file 12: Normal venous phase of an inferior mesenteric angiogram (same patient as in Image 11 in Multimedia). |
 | Media file 13: Plain supine abdominal radiograph in a 72-year-old man who presented with bloody diarrhea. Note the thumbprinting of the splenic flexure and the entire descending colon. |
 | Media file 14: Inferior mesenteric angiogram in the same patient as in Image 13 shows a stenosis of more than 50% at the origin of the left colic artery associated with a poststenotic dilatation. Image on the right is a manual subtraction image. |
 | Media file 15: Postoperative abdominal radiograph in a 26-year-old patient who had stabbed himself, cutting across the jejunum. The injury was repaired on an emergency basis. After laparotomy, his recovery was slow, and he had bloody diarrhea. Colonoscopy revealed a hemorrhagic edematous mucosa of the splenic flexure suggestive of ischemic colitis. Note the thumbprinting of the distal transverse colon. See also Image 16 in Multimedia. |
 | Media file 16: Axial contrast-enhanced CT scans of the same patient as in Image 15 in Multimedia shows that the superior mesenteric vein is larger than the aorta. Lower CT section (left) shows a fistula between the superior mesenteric artery and the vein through a pseudoaneurysm, which was the cause of global mesenteric ischemia due to a steal phenomenon. After surgical repair of the arteriovenous communication, the patient fully recovered. |
 | Media file 17: Series of contrast-enhanced CT scans (see Images 17-32 in Multimedia) on a 72-year-old man presenting with acute abdominal pain. Surgery revealed mesenteric ischemia, mainly in the right and transverse colon, secondary to peripheral mesenteric thrombosis (arrow). Note the colonic edema akin to thumb printing on plain abdominal radiographs. Multiple hypoattenuating masses in the liver were due to liver abscesses. Moderate ascites is present. |
 | Media file 18: Series of enhanced CT scans (see Images 17-32 in Multimedia) in the same patient. |
 | Media file 19: Series of enhanced CT scans (see Images 17-32 in Multimedia) in the same patient. |
 | Media file 20: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 21: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 22: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 23: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 24: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 25: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 26: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 27: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 28: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 29: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 30: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 31: Series of enhanced CT scans (Images 17-32) in the same patient. |
 | Media file 32: Series of enhanced CT scans (see Images 17-32 in Multimedia) in the same patient. |
More on Colitis, Ischemic |
| Overview: Colitis, Ischemic |
| Imaging: Colitis, Ischemic |
| Follow-up: Colitis, Ischemic |
 Multimedia: Colitis, Ischemic |
| References |
| Further Reading |
| « Previous Page |
References
Marston A, Pheils MT, Thomas ML. Ischaemic colitis. Gut. Feb 1966;7(1):1-15. [Medline].
Boley SJ, Schwartz S, Lash J, et al. Reversible vascular occlusion of the colon. Surg Gynecol Obstet. 1963;116:53-60.
Schuler JG, Hudlin MM. Cecal necrosis: infrequent variant of ischemic colitis. Report of five cases. Dis Colon Rectum. May 2000;43(5):708-12. [Medline].
Nielsen OH, Vainer B, Rask-Madsen J. Non-IBD and noninfectious colitis. Nat Clin Pract Gastroenterol Hepatol. Jan 2008;5(1):28-39. [Medline].
Steele SR. Ischemic colitis complicating major vascular surgery. Surg Clin North Am. Oct 2007;87(5):1099-114, ix. [Medline].
Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am. Feb 1992;72(1):203-29. [Medline].
Hwang RF, Schwartz RW. Ischemic colitis: a brief review. Curr Surg. Mar 2001;58(2):192-194. [Medline].
Zeitz M. Shock-associated nonocclusive ischemic colitis: a very rare event in young patients after trauma. Int J Colorectal Dis. Feb 2001;16(1):58-9. [Medline].
Mancuso MA, Cheung YY, Silas AM, Chertoff JD, Dickey KW. Case 120: ischemic colitis limited to the cecum. Radiology. Sep 2007;244(3):919-22. [Medline].
Zou X, Cao J, Yao Y, Liu W, Chen L. Endoscopic findings and clinicopathologic characteristics of ischemic colitis: a report of 85 cases. Dig Dis Sci. Sep 2009;54(9):2009-15. [Medline].
Stathaki MI, Koutroubakis IE, Koukouraki SI, Kouroumalis EA, Karkavitsas NS. Is there a role for Tc-99m (V) DMSA scintigraphy in ischemic colitis?. World J Gastroenterol. Sep 21 2008;14(35):5432-5. [Medline].
Antolovic D, Koch M, Hinz U, Schöttler D, Schmidt T, Heger U, et al. Ischemic colitis-analysis of risk factors for postoperative mortality. Langenbecks Arch Surg. Feb 20 2008;[Medline].
Punnam SR, Pothula VR, Gourineni N, Punnam A, Ranganathan V. Interferon-ribavirin-associated ischemic colitis. J Clin Gastroenterol. Mar 2008;42(3):323-5. [Medline].
Sheibani S, Gerson LB. Chemical colitis. J Clin Gastroenterol. Feb 2008;42(2):115-21. [Medline].
Yanagisawa A, Namai Y, Sekine T, Igarashi T. Ischemic colitis as a complication in a patient with steroid-dependent nephrotic syndrome. Pediatr Nephrol. Nov 24 2007;[Medline].
Flobert C, Cellier C, Berger A. Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis. Am J Gastroenterol. Jan 2000;95(1):195-8. [Medline].
Hunter GC, Guernsey JM. Mesenteric ischemia. Med Clin North Am. Sep 1988;72(5):1091-115. [Medline].
Antolovic D, Koch M, Hinz U, Schöttler D, Schmidt T, Heger U. Ischemic colitis-analysis of risk factors for postoperative mortality. Langenbecks Arch Surg. Feb 20 2008;[Medline].
Boley SJ, Brandt LJ, Veith FJ. Ischemic disorders of the intestines. Curr Probl Surg. Apr 1978;15(4):1-85. [Medline].
Sotiriadis J, Brandt LJ, Behin DS, Southern WN. Ischemic colitis has a worse prognosis when isolated to the right side of the colon. Am J Gastroenterol. Oct 2007;102(10):2247-52. [Medline].
Brandt L, Boley S, Goldberg L. Colitis in the elderly. A reappraisal. Am J Gastroenterol. Sep 1981;76(3):239-45. [Medline].
Fisher DF Jr, Fry WJ. Collateral mesenteric circulation. Surg Gynecol Obstet. May 1987;164(5):487-92. [Medline].
Alapati SV, Mihas AA. When to suspect ischemic colitis. Why is this condition so often missed or misdiagnosed?. Postgrad Med. Apr 1999;105(4):177-80, 183-4, 187. [Medline].
Yao T, Iwashita A, Hoashi T. Phlebosclerotic colitis: value of radiography in diagnosis--report of three cases. Radiology. Jan 2000;214(1):188-92. [Medline].
Taourel P, Aufort S, Merigeaud S, Doyon FC, Hoquet MD, Delabrousse E. Imaging of ischemic colitis. Radiol Clin North Am. Sep 2008;46(5):909-24, vi. [Medline].
Theodoropoulou A, Koutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol. Dec 28 2008;14(48):7302-8. [Medline].
Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: CT evaluation of 54 cases. Radiology. May 1999;211(2):381-8. [Medline].
Barkhausen J, Stoblen F, Dominguez-Fernandez E. Impact of CT in patients with sepsis of unknown origin. Acta Radiol. Sep 1999;40(5):552-5. [Medline].
Horton KM, Fishman EK. Computed tomography evaluation of intestinal ischemia. Semin Roentgenol. Apr 2001;36(2):118-25. [Medline].
Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics. Mar-Apr 2000;20(2):399-418. [Medline].
Ha HK, Lee EH, Lim CH. Application of MRI for small intestinal diseases. J Magn Reson Imaging. Mar-Apr 1998;8(2):375-83. [Medline].
Chung JJ, Semelka RC, Martin DR. Colon diseases: MR evaluation using combined T2-weighted single-shot echo train spin-echo and gadolinium-enhanced spoiled gradient-echo sequences. J Magn Reson Imaging. Aug 2000;12(2):297-305. [Medline].
Li KC, Whitney WS, McDonnell CH. Chronic mesenteric ischemia: evaluation with phase-contrast cine MR imaging. Radiology. Jan 1994;190(1):175-9. [Medline].
Wolff JH, Rubin A, Potter JD, Lattimore W, Resnick MB, Murphy BL, et al. Clinical Significance of Colonoscopic Findings Associated With Colonic Thickening on Computed Tomography: Is Colonoscopy Warranted When Thickening is Detected?. J Clin Gastroenterol. Mar 13 2008;[Medline].
Wiesner W, Willi UV. Nonocclusive ischemic colitis in a 12-year-old girl: value of unenhanced spiral computed tomography. Int J Colorectal Dis. Feb 2001;16(1):55-7. [Medline].
Danse EM, Van Beers BE, Jamart J. Prognosis of ischemic colitis: comparison of color doppler sonography with early clinical and laboratory findings. AJR Am J Roentgenol. Oct 2000;175(4):1151-4. [Medline].
Dirkx CA, Gerscovich EO. Sonographic findings in methamphetamine-induced ischemic colitis. J Clin Ultrasound. Nov-Dec 1998;26(9):479-82. [Medline].
Further Reading
Related eMedicine topics
Colitis, Pseudomembranous
Necrotizing Enterocolitis
Ulcerative Colitis
Keywords
colitis, ischemic colitis, reversible vascular occlusion of the colon, mesenteric ischemia, intestinal necrosis, mesenteric thrombosis, mesenteric infarction, transmural infarction, mucosal infarction, mural infarction
