Ischemic injury of the colon is caused by occlusion or insufficient blood perfusion of the arteries supplying the colon. It is commonly seen in hypovolemic shock, heart failure, embolism or thrombosis of the mesenteric arteries, or after reconstruction of the abdominal aorta or major arteritis. Acute colonic ischemia is transient and reversible, but in severe cases, transmural necrosis, perforation, or persistent intestinal ischemia may occur.

bubble_chart Diagnosis

Medical history and symptoms:

Sudden onset of spasmodic left lower abdominal pain or mid-abdominal pain, which may be accompanied by nausea, vomiting, or bloody diarrhea, usually with black or bright red stools within 24 hours. It is important to inquire whether it is combined with cardiovascular diseases. For young individuals, attention should be paid to whether they have been taking oral contraceptives for a long time.

Physical examination findings:

There may be tenderness in the left lower abdomen or throughout the abdomen, and sometimes a "mass" can be palpated in the left iliac fossa. Digital rectal examination may reveal blood on the glove. Severe cases may present with peritonitis or shock.

Auxiliary examinations:

There may be anemia and elevated white blood cell count, with red and white blood cells observed in stool routine tests. Colonoscopy may reveal congestion, edema, and brown necrotic nodules in the intestinal mucosa. Biopsy may show varying degrees of submucosal necrosis, hemorrhage, granulation tissue, fibrosis, or hyaline degeneration. Early barium enema may reveal grade I colonic dilation and may show typical thumbprinting signs.

It should be differentiated from inflammatory bowel disease, bacterial dysentery, etc.

Early and timely supportive treatment for pathology includes fasting, replenishing blood volume, maintaining water and electrolyte balance, and sustaining cardiac output. Antibiotics may be used to prevent infection, such as ampicillin 4.0g + 250ml normal saline, IV drip, twice daily, combined with metronidazole 400mg, IV drip, once daily. For severe cases with intestinal perforation or signs of peritonitis, exploratory laparotomy should be performed as early as possible.