Colon ischemia

Other vasospasm-related events Peripheral vascular ischemia and colonic ischemia with abdominal pain and bloody diarrhea have been reported with 5-HT- agonists. 

Constipation Serious complications of constipation, including obstruction, perforation, impaction, toxic megacolon, secondary colonic ischemia, and death have been reported with use of alosetron. Immediately discontinue alosetron treatment in patients who develop constipation. 

In the patient presenting with a recent onset of constipation, an obstructing lesion of the colon should be sought. In addition to a colonic neoplasm, other causes of colonic obstruction include strictures due to colonic ischemia, diverticular disease, or inflammatory bowel disease foreign bodies or anal strictures. Anal sphincter spasm due to painful hemorrhoids or fissures also may inhibit the desire to evacuate. 

Sparano JA, Dutcher JP, Kaleya R, Caliendo G, Fiorito J, Mitsudo S, Shechner R, Boley SJ, Gucalp R, Ciobanu N, et al. Colonic ischemia complicating immunotherapy with interleukin-2 and interferon-alpha. Cancer 1991 68(7) 1538-44. 

Ethylene glycol poisoning can canse acidosis, central nervous system depression, pulmonary edema, acute oliguric renal failure with crystalluria, liver damage due to calcium oxalate deposition, nausea, abdominal pain, and cramping, acute colonic ischemia (29), and papilledema and abducens nerve palsy (30). 

Boley JS (1990) Colonic ischemia 25 years later. Am J Gastroenterol 85 931-934... 

Colon ischemia has also been reported after IIA embolization [20, 28]. Karch et al. reported this complication in three of their 22 patients (14%) who had undergone IIA embolization [28]. All three patients had either accidental or intentional occlusion of bilateral IIAs during EVAR. The true risk of colon ischemia after IIA embolization, however, is difficult to quantify. This is due to the small number of reported cases and is likely to be substantially less than T diat was observed by Karch et al. and similar to that of the open surgical AAA repair. 

Karch/2000 [28] 22 32% NR 13.5% Three patients developed colon ischemia... 

Dadian N, Ohki T, Veith FJ et al. (2001) Overt colon ischemia after endovascular repair the importance of microembolization as an etiology. J Vase Surg 34 986-996... 

Lopez Morra HA, Fine SN, Dickstein G. Colonic ischemia with laxative use in young adults. Am J Gastroenterol 2005 100 2134-6. 

The clinical conditions that most often necessitate emergency colonic operations are acute hemorrhage, perforation, ischemia, obstruction and trauma. In these circumstances, the operation must be performed without any bowel preparation because oral antibiotic prophylaxis and mechanical cleansing are either impossible or potentially harmful. 

There is some reason to distinguish this from the ischemia that can be caused by oral contraceptives, in that it is restricted to the colon, can have a chronic or remitting course, can present with non-specific abdominal and colonic symptoms, can be reversible despite continued use of estrogen, and does not require surgical treatment. The symptoms of intestinal ischemia resolve within days to weeks after withdrawal of the estrogen. However, oral contraceptives have also been reported to cause ischemic colitis. 

Ischemia of the small bowel and colon after the use of cocaine has been reported (SEDA-22, 33). 

Gardner TB, Manning HL, Beelen AP, Cimis RJ, Cates JM, Lewis LD. Ethylene glycol toxicity associated with ischemia, perforation, and colonic oxalate crystal deposition. J Chn Gastroenterol 2004 38(5) 435-9. 

Henninger D D, Snyder J R, Pascoe J R et al 1992 Microvascular permeability changes in ischemia/repetfusion injury in the ascending colon of horses. Journal of the American Veterinary Medical Association 201 1191-1196... 

Moore R M, Bertone A L, Muir W W 1996 Effect of high-molecular weight dextran macromolecules on low-flow ischemia and reperfusion of the large colon in horses. American Journal of Veterinary Research 57 1067-1073... 

Instead of inducing spasm, another recently described technique that may not require super-selective catheterization is intra-arterial platelet infusion. This has been described in a few cases where bleeding was too diffuse to allow safe embolization [24]. In one LGI case, diffuse colonic bleeding was terminated by infusing 4 units of platelets into the proximal SMA. Presumably infusing platelets, which are normally present in the blood, should carry little risk of causing ischemia but both the safety and efficacy of this technique needs to be validated in larger series. 

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