Ischemic colitis-diagnostic and therapeutic challenges

Ischemic colitis (IC) is a rare condition. As ischemia is often transient and the clinical symptoms are reversible, its exact incidence is unknown. In current clinical practice, two types of IC are described according to the severity: severe IC, with transmural colonic ischemia and/or multiorgan failure (MOF), and mild IC, without MOF and spontaneous favourable evolution in most cases. Two clinical contexts are encountered: spontaneous IC (SIC) and postoperative IC (POIC), mainly after aortic surgery. As there are no specific clinico-biologic symptoms of IC, emergent CT scan and colonoscopy are required for diagnosis confirmation, surgical decision and prognosis analysis. IC surgical treatment is not consensual but can be standardized according to organ function and the degree of ischemia: surgery treatment in case of colonic necrosis with deep ischemia and/or MOF; observation for superficial ischemia without organ dysfunction, and systematic medical care. Surgery is required in 20% of cases and consists of different types of colonic resection including colectomy without continuity restoration and prophylactic cholecystectomy. Continuity restoration is feasible in one third of survivors, who are exposed to a high risk of severe cardiovascular events. Ischemic diseases of the gastrointestinal tract are some of the common gastrointestinal diseases which are difficult to diagnose and still more difficult to treat. The presentation of colon ischemia is even more subtle, and this review article details about the various presentation patterns of ischemic colitis and their management.