ABSTRACT

Colon ischemia is a frequent disorder of the large bowel and is the most common form of intestinal ischemic injury. There have been several changes in our concepts of this disease, from its early descriptions. In the 1950s, colon ischemia was considered synonymous with colon infarction or gangrene. Now we recognize that colon ischemia describes a pathophysiologic process that leads to a spectrum of clinical disorders including reversible colopathy (mucosal or intramural hemorrhage), transient colitis, chronic colitis, stricture, gangrene, and fulminant universal colitis. Previously, colon ischemia was thought of as a disease affecting older individuals, in whom an etiology was rarely discovered. Today, an increasing number of young people are being diagnosed with colon ischemia, mainly those who have an underlying thrombophylic condition, patients on a wide variety of medications, or those who use illicit drugs such as cocaine. Finally, we are learning that whereas the majority of patients with colon ischemia do well, there are some in whom prognosis is more guarded. This is especially true when only the right side of the colon is affected [within the distribution of the superior mesenteric artery (SMA)], as is seen in dialysis patients, patients recovering from cardiac surgery, patients who have had shock or sepsis, and when the SMA flow is compromised.