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Fulminant Colitis
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Michael F. Musso, Adrian W. Ong
Causes of ischemic colitis are generally divided into occlusive disease (e.g., surgery, thromboemboli, vasculitides) and non-occlusive disease (e.g., various shock etiologies, drugs). Segmental involvement of the colon is typical, with the left colon being most commonly affected. Pancolonic involvement is unusual, occurring in 13% in one study [11]. While 50–60% have non-gangrenous IC that resolves with resuscitation and empiric antibiotics, the remainder will develop irreversible colonic damage manifested by gangrene, stricture, or, rarely, a fulminant course characterized by a toxic, rapidly progressing course with colectomy being necessary [12].
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What other complications of ischaemic colitis are there?Some patients develop a chronic ischaemic colitis, with recurrent abdominal pain, infections, bloody diarrhoea and weight loss. Strictures can also occur. Both of these should prompt consideration of segmental colectomy.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Ischemic colitis results from compromise to the colonic blood supply, either by global changes in circulation or by local changes in mesenteric vasculature. As such, findings occur in a territorial distribution, typically in watershed areas, particularly the splenic flexure (superior mesenteric artery/inferior mesenteric artery junction) and the rectosigmoid junction (inferior mesenteric artery/hypogastric artery junction). It is the most common form of gastrointestinal ischemia, is usually transient and self-limited, and the cause is often somewhat elusive and multifactorial. Most of the patients affected are elderly, with non-specific abdominal pain, and occasionally bloody diarrhea. It is associated with cardiovascular disease, numerous medications, coagulopathic states, and hypovolemia. Again, bowel wall thickening, mucosal irregularity, and pericolic inflammatory changes may be seen on CT. Specific, but uncommon, findings for bowel ischemia include pneumatosis (in the correct clinical context), which may be difficult to distinguish from intraluminal gas in some patients, and the absence of submucosal enhancement in the region of infarction [3,61].
Increased risk of inflammatory bowel disease among patients treated with rituximab in Iceland from 2001 to 2018
Published in Scandinavian Journal of Gastroenterology, 2021
Valdimar B. Kristjánsson, Sigrún H. Lund, Gerður Gröndal, Signý V. Sveinsdóttir, Hjálmar R. Agnarsson, Jón G. Jónasson, Einar S. Björnsson
Two cases were classified as indeterminate IBD, as they never received a definitive diagnosis during the study period. In these cases, the patients underwent several colonoscopies, but the biopsies were not consistent with either ulcerative colitis or Crohn’s disease. One case, a 55-year-old male who developed severe gastrointestinal symptoms – including abdominal pain and watery diarrhoea up to 15 times per day – who finally required an ileostomy to relieve his colitis. He underwent a total of six colonoscopies. The pathological examination showed features of pseudomembranous colitis but also displayed features of bacterial colitis, ischemic colitis, and drug-induced colitis. Cultures for Clostridium difficile, other bacteria, viruses, and parasites known to lead to colitis were repeatedly negative. The endoscopic picture consisted of severe erythema and swelling of the mucosa with an absence of any vascular pattern and in some endoscopies revealed inflammatory polyps and prolific mucous. Macroscopically, the mucosa did not show signs of ‘pseudomembranous colitis’ as seen with C. difficile. However, pseudomembranous colitis is not only caused by C. difficile and can be seen in both drug-induced colitis and colitis caused by other pathogens [20].
Treatment with indigo naturalis for inflammatory bowel disease and other immune diseases
Published in Immunological Medicine, 2019
Recently, IN-induced colitis has been reported. Kondo et al reported that two cases who received oral IN powdered form developed colitis with wall thickening and edema in the right colon [30]. Yanai et al. also reported reddish and edematous lesions in the ascending colon during treatment with IN [31]. Colitis disappeared after discontinuation of IN. Fhang et al reported a case of ischemic colitis induced by IN; the patient was successfully treated using laparoscopic sigmoid colectomy, and pathological examination revealed ischemic or toxic injury of the sigmoid colon [32]. More recently, Matsuno et al also reported on two cases of IN-induced colitis [33]. One was a case of colitis with wall thickness of the ascending colon and an ileocecal intussusception and the other was a case of colitis with marked wall thickening of the right colon. These cases of IN-induced colitis developed relatively early after IN administration and mainly occurred in the right colon. IN-induced colitis may be more likely to occur in right colon because IN tends to be stored in this region.
Causes of gastrointestinal bleeding in oral anticoagulant users compared to non-users in a population-based study
Published in Scandinavian Journal of Gastroenterology, 2022
Arnar S. Ágústsson, Arnar B. Ingason, Edward Rumba, Daníel Pálsson, Indriði E. Reynisson, Jóhann P. Hreinsson, Einar S. Björnsson
A significant reduction of ischemic colitis (IC) in OAC users might be associated with a clinically significant reduction in morbidity and mortality of these patients and requires further investigation. This finding could suggest that OACs treatment could be more protective in IC than in other atherosclerotic diseases, such as myocardial infarction or ischemic stroke [31,32]. That could be explained by the central role of hypercoagulability in IC with a significant increase in thrombophilic factors and a high incidence of concurrent thrombophilic disorders [33,34]. It is conceivable that OACs decrease the risk of ischemic colitis by preventing hypercoagulability although further studies are needed to confirm this novel observation.