This document summarizes information about ischemic colitis (CI). CI is often underdiagnosed but is a common condition that presents with non-specific symptoms. It most frequently affects the elderly and women. Treatment depends on the severity, location and duration of the CI. Potential risk factors include hypertension, diabetes, cardiovascular disease and previous abdominal surgeries. Correct diagnosis and identification of underlying causes is important for prognosis. Surveillance endoscopies may be considered for detecting strictures. Prompt treatment is important as delays can increase mortality rates.

1. Kurdistan Board GEH/GIT Surgery J Club 2022
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 The clinical&endoscopic features of CI are non-specific.
 CI is correctly identified at the time of presentation in only 9%.
 The true incidence is likely underestimated because many mild cases
resolve spontaneously without medical treatment.
 Most CI are transient&no specific cause detected,so often labled idiopathic
 In severe CI correct diagnosis, prompt recognition, therapy &
identification of underlying causes are crucial for a favorable outcome.
 Less severe&mild cases may present with similar symptoms,but prognosis/
management are completely different&managed conservatively.
 Endoscopic follow-up to detect chronic, recurrent/or strictures may be
considered.
 The SMA&IMA are both responsible for blood supply to the colon.
 The high density of the collateral vascular pathway (the marginal artery of
Drummond& the arc of Riolan) protects the entire colon from ischemic
injury,but the vasa recta (end-vessels providing blood to colon) are less
dense in the right colon, splenic flexure, rectosigmoid& hepatic flexure.

3. Introduction:
 Diagnosed in 9—24% of patients hospitalized for LGIB.
 CI most commonly occurs in elderly 80%& women 76%,but also youngs.
 The true incidence is difficult to estimate due to broad clin spectrum.
 CI findings can encompass inflammation, mucosal ulceration,
haemorrhage, pseudo-tumoral appearance&transmural necrosis.
 In most cases, ischemic damage is transient&reversible.
 In some cases, ulcerations/strictures, even asymptomatically, may persist
for several months before resolution.
 Irreversible consequences aused by transmural colonic damage that lead to
gangrene,fulminant colitis& multi-organ failure.
 Treatment options are determined by the severity.
 Rising with increased life expectancy with underlying comorbiditie&
increased recognition with CT/ endoscopy.
 Male gender is a predictor of poor prognosis,
 The overall mortality rate is 12%.

4. Types:
 Location:pan 10%,right(proximal to hepatic flexure) in 4.5-26%&left in
23-80% (55% recto-sigmoid, 25% splenic flexure),rectal very rare (2-5%).
 Severity:gangrenous colitis (15—20%), non-gangrenous type(80—85%) or
as severe, moderate& mild colitis.
 Duration:Reversible, transient, recurrent or chronic segmental colitis.
 Reversible(3—26%); self-limited,involving the superficial mucosa with
submucosal haemorrhaging, promptly resorbed within 3 days.
 Transient IC (45%);temporary full-thickness colonic involvement
associated with abdominal pain / bleeding,
 Recurrent; second episode following resolutiona;15% over three years
 Chronic ulcerative or segmental (17.9—25%) present with or without
stricture formation,with histologically confirmed& with persistent abd
symptoms for>mons.
 Ischemic colonic stricture (10—15%) may be diagnosed as acute,
frequently seen in asymptomatics&resolves spontaneously within 12—24
mons.

5. RFs:
 Hypertension the most common comorbidity (58%).
 DM(24%)
 Cardiovascular disease (23.8%)
 Nephropathy (15%)
 AF (14.3%) [13,54], particularly in IRCI cases.
 A history of previous surgery (i.e.GI surgery, abdominal aortic aneurysm
surgery, or major CV surgery) in 3.9—79.1%
 Predictors of a poor prognosis are male gender, tachycardia, absence of
rectal bleeding, peritonitis, shock, hypotension (<90 mmHg) &IRCI.

13. Key points:
 CI is often clinically under appreciated,but common, acute& chronic dis.
 CI can affect young people with or without predisposing factors.
 Underlying hypercoagulable states may induce CI,including those
associated with COVID-19 infection.
 Accurate diagnosis will decrease the number of CI cases that are
incorrectly diagnosed as idiopathic.
 Treatment management differs according to the type of CI.
 Anticoagulant/ corticosteroids show promise for the treatment of severe &
moderate disease.
 Endoscopic surveillance at regular intervals following onset of disease can
be considered for early detection& treatment of subsequent strictures.
 Endoscopic dilation could be an alternative to surgery for symptomatic
strictures.

14. Conclusion:
 CI is a common & usually benign disease.
 The prognosis epends on the length of colon involved & the severity f
damage.
 Correct identification, prompt recognition of any underlying cause &
selection of treatment based ons everity are crucial.
 Ideally, A MD approach is necessary.
 Prompt diagnosis is essential because mortality rates significantly increase
when treatment is delayed.