31st July 2023

Ischaemic Colitis

Describes compromised blood flow to the large bowel. Severity can range from mild ischaemia to severe gangrenous colitis. Most commonly occurs at ‘watershed’ areas, such as the splenic flexure (Griffiths point), which is located at the border of the territory supplied by the superior and inferior mesenteric arteries.

The most common symptoms are left iliac fossa pain and haematochezia.

Abdominal XR may reveal ‘thumbprinting’ due to submucosal oedema. CT is usually diagnostic, with bowel walls thickening a common feature.

Management is conservative in the first instance and involves fluids and antibiotics. A small proportion of patients will require bowel resection with stoma formation.

Complications in severe ischaemic colitis include ongoing haemorrhage, bacterial contamination causing peritonitis and perforation.

Watershed areas of the colon. 

Image Source: Wikimedia Commons (2008). Colonic blood supply, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Colonic_blood_supply.svg (Accessed: 28 June 2023).