What are the sequelae of ischemic colitis? Can anything be done to modify the course of the disease?
Optimizing cardiac function is imperative; impaired cardiac output and cardiac arrhythmias should be corrected. Factors predisposing to vasoconstriction, digoxin therapy, vasopressor agents, and hypovolemia should be avoided when possible. Vasodilating agents are ineffective because low colonic blood flow has often already returned to normal by the time the ischemia has occurred. It is recommended that the patient be treated with intravenous fluids and bowel rest. A distended colon should be decompressed colonoscopically by placement of a rectal tube or by rolling the patient from a supine position to right and left lateral decubitus positions. If the precipitating event is occlusive in nature, the underlying cause should be corrected, possibly including prolonged anticoagulation. Thus far there is no objective evidence demonstrating the effectiveness of antibiotics.
Ischemic colitis is reversible in up to 70% of patients whose symptoms abate within 24 to 48 hours; in these patients, healing occurs without stricture in 1 to 2 weeks. Those with severe injury require 1 to 6 months to heal completely. Irreversible damage occurs in less than 50% of cases and can lead to toxic megacolon, gangrene and perforation, fulminant colitis, and ischemic strictures. Unfortunately, the course cannot be predicted at the time of initial presentation.
Isolated right-sided ischemic colitis has a higher mortality and need for surgery, as its pathophysiologic findings are closely related to AMI. The diagnosis and management of isolated right-sided ischemic colitis therefore mirrors that of AMI.