Ischemic colitis other diagnostic studies: Difference between revisions

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==Colonoscopy==
==Colonoscopy==
* Colonoscopy for ischemic colitis is as follows:<ref name="TheodoropoulouΚoutroubakis2008">{{cite journal|last1=Theodoropoulou|first1=Αngeliki|last2=Κoutroubakis|first2=Ioannis E|title=Ischemic colitis: Clinical practice in diagnosis and treatment|journal=World Journal of Gastroenterology|volume=14|issue=48|year=2008|pages=7302|issn=1007-9327|doi=10.3748/wjg.14.7302}}</ref><ref name="WashingtonCarmichael2012">{{cite journal|last1=Washington|first1=Christopher|last2=Carmichael|first2=Joseph|title=Management of Ischemic Colitis|journal=Clinics in Colon and Rectal Surgery|volume=25|issue=04|year=2012|pages=228–235|issn=1531-0043|doi=10.1055/s-0032-1329534}}</ref>
* Colonoscopy findings for ischemic colitis are as follows:<ref name="TheodoropoulouΚoutroubakis2008">{{cite journal|last1=Theodoropoulou|first1=Αngeliki|last2=Κoutroubakis|first2=Ioannis E|title=Ischemic colitis: Clinical practice in diagnosis and treatment|journal=World Journal of Gastroenterology|volume=14|issue=48|year=2008|pages=7302|issn=1007-9327|doi=10.3748/wjg.14.7302}}</ref><ref name="WashingtonCarmichael2012">{{cite journal|last1=Washington|first1=Christopher|last2=Carmichael|first2=Joseph|title=Management of Ischemic Colitis|journal=Clinics in Colon and Rectal Surgery|volume=25|issue=04|year=2012|pages=228–235|issn=1531-0043|doi=10.1055/s-0032-1329534}}</ref>
** Colonoscopy is more sensitive and allows visualization of colonic mucosa and histological analysis of biopsies.
** Colonoscopy is more sensitive and allows visualization of colonic mucosa and histological analysis of biopsies.
** Diagnosis requires colonoscopy within 48 hours.
** Diagnosis requires colonoscopy within 48 hours.

Revision as of 21:00, 8 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Among patients with a suspicion of ischemic colitis, endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the diagnostic procedure of choice if the diagnosis remains unclear after other imaging studies.

Endoscopy

  • Early endoscopy can confirm the diagnosis and provides prognostic information.
    • Distinguishes between cases that need conservative management versus those that require emergency resection.
  • Transient non-gangrenous features of ischemic colitis observed at colonoscopy include:
    • Petechial haemorrhages
    • Edematous and fragile mucosa
    • Segmental erythema
    • Scattered erosions
    • Longitudinal ulcerations (colon single stripe sign)
    • A sharply defined segment of involvement
  • Transmural ischemia will show:
    • Cyanosis and pseudo-polyps

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Colonoscopy

  • Colonoscopy findings for ischemic colitis are as follows:[2][3]
    • Colonoscopy is more sensitive and allows visualization of colonic mucosa and histological analysis of biopsies.
    • Diagnosis requires colonoscopy within 48 hours.
    • Serial studies in connection with the clinical setting are necessary to establish the diagnosis.
    • Performed with limited insufflation to avoid over distension of the colon.
    • Could lead to further ischemia or perforation.
    • CO2 insufflation rather than air should be used
      • CO2 is rapidly absorbed and acts as a vasodilator.

References

  1. MacDonald, P.H. (2002). "Ischaemic colitis". Best Practice & Research Clinical Gastroenterology. 16 (1): 51–61. doi:10.1053/bega.2001.0265. ISSN 1521-6918.
  2. 2.0 2.1 Theodoropoulou, Αngeliki; Κoutroubakis, Ioannis E (2008). "Ischemic colitis: Clinical practice in diagnosis and treatment". World Journal of Gastroenterology. 14 (48): 7302. doi:10.3748/wjg.14.7302. ISSN 1007-9327.
  3. Washington, Christopher; Carmichael, Joseph (2012). "Management of Ischemic Colitis". Clinics in Colon and Rectal Surgery. 25 (04): 228–235. doi:10.1055/s-0032-1329534. ISSN 1531-0043.