Spontaneous ischemic colitis

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Abstract
Cases (18) of spontaneous ischemic colitis are reviewed. The diagnosis was established according to the following criteria: clinical background, clinical characteristics, morphologic characteristics and clinical and morphologic course. The last 3 constituted the diagnostic criteria. The cases were divided into mild-to-moderate, moderate-to-severe and gangrenous categories. Spontaneous ischemic colitis generally occurs in older individuals; the average age in the patients was 60 yr. Of the 18 major patients 12 had at least some evidence of major cardiovascular disease. As for clinical characteristics, sudden onset of the disease was typical. Abdominal pain and diarrhea were a constant finding. Morphologically, segmental distribution was characteristic. Hemorrhage and edema of the mucosal wall were characteristic. Pseudomembranes, erosions and ulcers were present in more severe cases. Pale, greenish, yellowish necrotic surfaces were prominent in very severe-to gangrenous cases. Antibiotics appeared to shorten the course of the disease. In 7 of the 10 cases, the morphologic basis of healing was demonstrated by BA-enema and/or colonoscopy. In the moderate-to-severe category all except 1 patient had operations. Both patients in the gangrenous category underwent operation. Of the 4 patients undergoing resection and anastomosis 2 developed anastomotic leaks; in 1 case this led to death. Six patients underwent arteriography, 5 in the mild-to-moderate and 1 in the moderate-to-severe cateogry. In 4 of these cases, a local vascular basis of ischemic colitis was documented.

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