American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care

Colon Ischemia

Overview

Colonic ischemia occurs when there is not enough blood reaching the colon (i.e., large bowel or large intestine). This leads to irritation of the colon wall. In some cases, there can be infection or a break in the colon wall. Symptoms include sudden belly pain, rectal bleeding or diarrhea. Colonic ischemia is a medical emergency. Early treatment is helpful to restore blood flow and colon function.

  • What is colonic ischemia?
    • Irritation of the colon wall from low or blocked blood flow.
    • A blockage can be partial or complete.
  • When should I see/contact a doctor about colonic ischemia?
    • Colonic ischemia can be a medical emergency, especially if it is acute. Seek immediate medical attention if you experience sudden, severe abdominal pain with or without non-bloody diarrhea. You should also contact your health care provider if you have sudden abdominal pains associated with bloody diarrhea.
  • What are signs and symptoms of colonic ischemia?
    • Signs and symptoms may include:
      • Belly pain.
      • Red or maroon blood in the stool.
      • Diarrhea.
      • Bloating.
      • Fever.
      • Nausea or vomiting.
      • Urgency to have a bowel movement.
      • Feeling light in the head or dizzy.
    • Symptoms can start suddenly or happen over time.
  • What causes colonic ischemia?
    • The most common cause is low blood pressure. Reasons for low blood pressure include:
      • Dehydration
      • Heart failure
      • Trauma
      • Infection spreading through the blood
      • Severe immune reactions
      • Medications
    • Fatty deposits (atherosclerosis) or blood clots in vessels sending blood to the colon.
  • What are risk factors for colonic ischemia?
    • Low blood flow to part of or the whole body.
    • Blood clots in certain parts of the body.
    • Extreme exercise.
    • Surgeries for your heart or major blood vessels.
    • Colonoscopy.
    • Medications, like opioids, that make it hard to have a bowel movement.
    • Cocaine or amphetamines.
    • Inflammation of blood vessels (vasculitis).
    • Blockage in the colon from causes like colon cancer or scar tissue in the belly (outside the colon).
  • How do doctors diagnose colonic ischemia?
    • Taking a complete medical history.
    • Using imaging tests like an X-ray or CT to assess the inside of your body. Someone with colonic ischemia may have a swollen or torn colon wall.
    • Using special imaging tests to view blood vessels. These tests check for narrowed or blocked vessels.
    • Doctors may use a thin, flexible tube with a lighted camera at its tip (endoscope) to see inside the colon. A patient with colonic ischemia will have a swollen or irritated colon wall. Doctors may take samples inside the colon to review under a microscope.
    • They may use lab tests to help find a cause of ischemia.
  • How do doctors treat colonic ischemia?
    • The goal of treatment is to restore blood supply to the colon and maintain its function. Choice of treatment depends on the cause and the severity of damage. Options include:
    • Giving fluids or blood in your vein.
    • Widening a narrowed blood vessel or removing a blood clot.
    • Surgery to fix or remove all or part of the colon.
  • What is the outlook for people with colonic ischemia?
    • Most do well with simple treatments like fluids through the vein.  Fluids help keep their blood pressure normal.
    • The irritation to the colon wall can be reversible if patients are treated early.
  • Am I at risk for developing other conditions?

    The most severe forms of colonic ischemia can lead to complications such as:

    • Rupture: A hole in the colonic wall can form, causing the contents of the colon to leak into the abdominal cavity.
    • Peritonitis: A rupture can lead to peritonitis, a serious infection and inflammation of the abdominal cavity lining.
    • Scarring or narrowing of your colon: Even if the colon recovers from ischemia, scar tissue that narrows the colon can form during the healing process.
    • Tissue death: Sudden, complete blockage of blood flow to your colon can cause gangrene (tissue death) of the colon tissue.

Author(s) and Publication Date(s)

Paul Feuerstadt, MD, FACG, Gastroenterology Center of Connecticut, Hamden, CT – Published June 2019.

Ami J. Panara Shukla, MD, University of Miami, Miami, FL – Updated April 2024.

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