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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report 7 new cases of colitis above a carcinoma. The study of these cases and of those reported in the literature shows the main pathological characteristics of the lesions and permits discussion of the pathogenesis. Chronic ischemia caused by an increase in intraluminal pressure above the neoplastic stenosis seems to be the main etiological factor.
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PMID:[Colitis marginal to cancer. Apropos of 7 cases]. 18 88

Blood flow disturbances in the gastrointestinal tract can lead to serious illness. They can be acute or chronic, their cause may be arterial or venous occlusion or hypotonia. Lesions of the gastrointestinal tract caused by ischemia depend on localisation, acuteness and degree of the blood flow disturbance. They may reach from focal and segmental ischemic lesions to extensive necroses of the entire intestinal tubes. The most serious ischemic disease is the embolic and thrombotic occlusion of the arteria mesenterica superior due to previous arterosclerotic damage. Infarction of a large part of the intestines and peritonitis can be the consequence. These patients' only chance of survival is early diagnosis--as a rule exclusively via angiography--and immediate surgery. Chronic occlusion of the arteria mesenterica superior leads to angina abdominalis which mainly occurs after food intake and can last for hours. The reason may also be a general arteriosclerosis. Men are affected more frequently and at a younger age than women. As a consequence of lowered intestinal blood flow these patients suffer from malabsorption and heavy weight loss. Conservative therapy is not effective. These patients, too, will have to be treated surgically after previous angiography. Vascular disease with decreased blood flow as its consequence can be found in a number of inflammatory diseases, in malign hypertensian, in collagen disease and in other more rare diseases as pseudoxanthoma elasticum or Ehlers-Danlos-syndrome. In the case of ischemic colitis arterial and more rarely venous occlusions cause decreased blood flow in the big bowel. A frequent consequence is colitis in the left colon which is characterized by acuteness, pain in the left side of the abdomen and by heavy rectal bleeding. Diagnosis is established by means of endoscopy, barium enema and angiography. Primarily therapy of ischemic colitis is of the conservative type. In severe cases with gangrene and peritonitis the colon has to be resected.
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PMID:[Disorders of the blood circulation in the gastrointestinal tract]. 32 26

A case report of subacute, reversible ischemic colitis associated with use of oral contraceptives (OCs) is reported. A 19-year-old woman was admitted to the hospital with chief complaints of abdominal cramps, nausea, vomiting, diarrhea, and rectal bleeding of 2 days' duration. Past medical history and family history were noncontributory. The patient was receiving no medication other than Norinyl 2 (2 mg of norethindrone and .1 mg of mestranol), which she had been taking for 6 months. 2 days before admission the patient had taken 100 mg of dimenhydrinate and 2 ExLax tablets (90 mg of phenolphthalein) for constipation. Colonic roentgenograms revealed impaired mesenteric circulation and bowel ischemia; OC-induced ischemic bowel disease was diagnosed. Patient symptoms subsided within 96 hours of discontinuing the OC and initiating supportive therapy (including intravenous fluid infusion, nasogastric suction, analgesics, and antiemetics). When a repeat barium enema was performed, it showed resolution of the ischemia. In a short review following the case report, these drugs were indicted in causation of colitis-like syndrome: amoxicillin, ampicillin, cephazolin, chloramphenicol, chlorpropamide, clindamycin, cloxacillin, cotrimoxasole, cyclophosphamide, digitalis, ergotamine tartrate, flucytosine, fluorouracil, gold salts, laxative and cathartic abuse, mercurous chloride, methyldopa, penicillin V, and tetracycline. Ischemic bowel disease secondary to OC use is a rare but important complication because of its significant morbidity and potential mortality, and because of the widespread use of the drugs. The case report emphasizes the need to consider the differential diagnosis of acute vascular insult with bowel ischemia when acute abdominal pain progressing to bloody diarrhea occurs in young women taking OCs.
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PMID:Oral contraceptive-induced ischemic bowel disease. 48 72

With few exceptions, the incidence of left colon ischemia following abdominal aortic reconstruction has been reported to be one to 2 percent. All reports of such ischemic events are retrospective analyses of clinically manifest or autopsy. Fifty patients were studied prospectively to determine more accurately the incidence of this complication. Aortic reconstruction was performed in 23 patients for occlusive disease (OD) and in 27 for aneurysm disease (AD). No emergency operations were performed. All patients underwent colonoscopy within 4 days of operation. Three instances of colon ischemia were noted, an incidence of 6 percent (OD 4.3 percent, AD 7.4 percent). Each patient recovered uneventfully. Two patients had diarrhea, but only after colon ischemia was recognized. Arteriographic opacification of the inferior mesenteric artery by the superior mesenteric artery collateral (meandering mesenteric artery) was documented in 35 percent of patients with OD and in 27 percent of patients with AD. Colon ischemia did not develop when this collateral was identified. The inferior mesenteric artery was patent at the aorta in all who developed colon ischema. Although clinically significant colitis following aortic reconstruction is rare, colonoscopy after operation may prove to be valuable for early recognition of ischemic changes before clinical manifestations preclude effective management.
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PMID:Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study. 96 29

The authors present a case review of a congenital abnormality of the inferior mesenteric blood vessels which resulted in ischemia of the descending colon and rectosigmoid area. The resulting colitis is only very rarely secondary to a vascular congenital abnormality. In this case, rectosigmoidoscopy, barioum study of the large bowel and a biopsy of the rectal mucosa pointed towards the ischemic nature of the lesion. This led to the selective angiographic study of the inferior mesenteric vessels with findings of a dilated inferior mesenteric artery and angiodysplasia. Surgical treatment included tying off of the inferior mesenteric artery and resection of the descending and rectosigmoid colon followed by transverse colon-rectum anastomosis. The angiographic and histopathologic studies were of great importance in establishing the true nature of the patient's clinical syndrome. One must keep in mind that the rectosigmoidoscopic findings may be seen in other disease states which do not have a vascular origin. These include Crohn's disease, severe amoebiasis and penumatosis of the intestine.
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PMID:[Angiodysplasia of the colon]. 103 Dec 18

Nonspecific colitis proximal to an obstructing colonic carcinoma has appeared in the surgical literature for over 20 years, but it remains an uncommon and difficult clinical problem. This report details the case histories of five patients with this entity who have been admitted to the surgical service of Presbyterian Hospital since 1967. The colitis described is clearly related to the obstructive lesion and does not represent chronic inflammatory colitis in association with a carcinoma. The patients may initially have symptoms secondary to the obstructing lesion or fulminant peritoneal signs secondary to the colitis. The roentgenographic appearance is typical and closely resembles that seen in colonic ischemia. The pathologic process varies from fibrosis and stricture formation to transmural necrosis and perforation.
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PMID:Colitis proximal to obstructing colonic carcinoma. 115 67

Because plain films are usually normal or nonspecific in both colonic and acute mesenteric ischemia, they are not diagnostically helpful. The barium enema is the most useful radiographic examination in the diagnosis of colonic ischemia, and a double-contrast study will show abnormalities in almost all cases. Findings specific for colonic ischemia characteristically change with time. Thumbprinting is the most diagnostic finding; it is seen early in the course of the disease and usually resolves or is replaced within 1 or 2 weeks by an acute ulcerating colitis pattern. The latter may heal over months or go on to stricture formation or a persistent colitis. Nonspecific abnormalities can also be identified on CT and ultrasound, but the incidence of the findings with colonic ischemia is not known. Plain film findings occur late in the course of acute mesenteric ischemia and thus cannot be relied on for the diagnosis, although they may be useful in excluding other conditions. When acute mesenteric ischemia is suspected, angiography should be performed, but CT, ultrasound, and, perhaps, MR imaging may contribute to the diagnosis.
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PMID:Radiology in intestinal ischemia. Plain film, contrast, and other imaging studies. 173 79

A case of urticarial vasculitis syndrome is described in which the gastrointestinal disease was the main clinical manifestation. The gastroduodenal barium meal demonstrated signs compatible with intestinal ischemia which reversed upon medical treatment. The colonoscopy with biopsy showed changes compatible with unspecific colitis. The role of reversible acute vasculitis as a pathogenic factor implicated in the gastrointestinal manifestations in this entity is discussed. Although the response to treatment with corticoids and cochicine was not constant, there was good response to dapsone in successive relapses of the disease. Despite some antibodies becoming positive during the third year of follow up, the patient did not fulfill the clinical criteria for the diagnosis of systemic lupus erythematosus.
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PMID:[Gastrointestinal involvement and the response to dapsone in a case of the urticarial vasculitis syndrome]. 177 Aug 22

Acute abdomen was the presenting manifestation of pseudomembranous colitis in six men who had previously been treated with antibiotics and presented with abdominal distention, pain, fever, and leukocytosis with absent or mild diarrhea. Plain abdominal radiographs revealed megacolon in two, combined small and large bowel dilation in three, with one of them showing volvuluslike pattern, and isolated small bowel ileus in one. Emergency colonoscopy was performed successfully in all patients and revealed pseudomembranes in five and nonspecific colitis in one. All patients had positive latex test results for Clostridium difficile, and two tested positive for cytotoxicity. All patients were treated with IV metronidazole, resulting in resolution of symptoms and abdominal findings. In addition, two patients underwent colonoscopic decompression with improvement. Endoscopically, complete resolution of the pseudomembranes occurred at 4 weeks in all cases. No patient had a recurrence. It is concluded that (a) pseudomembranous colitis may present as abdominal distention mimicking small bowel ileus. Ogilvie's syndrome, volvulus, or ischemia; (b) in such cases, emergency colonoscopy is safe and useful for diagnosis and therapeutic decompression and may obviate the need for surgery; and (c) treatment with IV metronidazole is effective. Colitis due to C. difficile should be considered in the differential diagnosis of acute abdomen in patients previously treated with antibiotics.
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PMID:Acute abdomen as the first presentation of pseudomembranous colitis. 161 51

The hypothesis that a significant reduction in colonic mucosal perfusion, and hence ischemic injury, precedes the development of mucosal ulceration and inflammation is tested in this report. The microcirculatory changes in the rat colonic mucosa within 1 hr of topical exposure to 10% acetic acid were assessed. Colonic mucosal blood flow signals measured by laser Doppler flowmetry were significantly reduced to 61 +/- 8, 52 +/- 10, and 37 +/- 13% (mean +/- SEM) of baseline values at 1 min, 4 min, and 10 min after the colonic mucosa was exposed to 10% acetic acid, respectively, but not in controls exposed to saline. After the start of application of 10% acetic acid (for 4 min), in vivo microscopy studies demonstrated that colonic mucosal ischemia (stasis of the red blood cells in the mucosal capillaries) occurred at 9 +/- 5 min (mean +/- SEM). Evidence of endothelial cell death (failure to exclude a fluorescent dye, propidium iodide, by endothelial cells) developed at 25 +/- 10 min (mean +/- SEM). These findings indicate that within minutes after contact of the colonic mucosa with 10% acetic acid, colonic mucosal ischemia develops, followed shortly by death of endothelial cells. The data do not establish a cause-and-effect relationship between the reductions in mucosal blood flow and loss of endothelial cell viability in response to acetic acid. Nevertheless, because these events occur at such an early time point, they may play a pathogenetic role in the development of the subsequent inflammatory and ulcerative changes in this animal model of colitis. Further studies to define the potential causal relationships between these parameters are warranted.
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PMID:Mucosal vascular stasis precedes loss of viability of endothelial cells in rat acetic acid colitis. 203 12


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