Ischemic colitis, description of the disease, risk group, treatment methods. Treatment of ischemic colitis The most common cause of ischemic colitis is

The large intestine is supplied with blood by the mesenteric arteries, the upper of which supplies blood to the small, ascending, blind and partially transverse colon of the intestine, and the lower - the left colon. When ischemia of colonic structures occurs, most of the microorganisms that populate them provoke the development of an inflammatory process in the intestinal wall, up to transient bacterial invasion.

Against the background of inflammation caused by ischemia, connective tissue and even fibrous structures are formed. The pathology is most typical for elderly patients. According to statistics, in patients with colitis after 50 years of age, in more than 75% of cases the ischemic form of the pathology is diagnosed.

Definition

Ischemic colitis is called either inflammation of the colon tissues that occurs against the background of impaired blood supply to the intestinal walls. Such disorders arise due to narrowing or occlusion of the vascular passages, resulting in the development of an inflammatory process, stricture, and then.

The affected area of the intestine does not receive enough blood supply, which leads to its dysfunctional disorders. Pathology occurs equally often in patients of both sexes. Although the pathology is typical for elderly patients, it can still affect able-bodied patients.

Causes of pathology

Intestinal inflammation of the ischemic form is a fairly complex pathological condition and is provoked by many factors.

The most common causes of ischemic colitis are:

, in which the vascular tissues located in the intestinal structures become inflamed;
Hypoperfusion - with the progression of this pathology, intestinal blood supply decreases, which subsequently leads to ischemic lesions of certain areas;
DIC syndrome;
Aortic dissection;
Anemia;
, in which fatty deposits accumulate on the walls;
, in which blood clots block the vascular lumen, which leads to ischemia;
Liver transplant;
idiopathic form;
Some types of drug therapy, such as hormone therapy.

There are many causes of ischemic intestinal inflammation, but they all have a connection with vascular spasms. The colon is poorly supplied with blood, and against the background of shock, large blood losses, myocardial failure or dehydration due to intestinal infections leads to the rapid development of ischemia.

Forms

Like many other pathologies, ischemic colitis can occur in a chronic or acute form. In addition, acute colitis can occur:

With the progression of an intramural type of infarction, when the necrotic focus has an intramural localization;
With a predominance of infarction of the intestinal mucosa, in which necrosis occurs against the background of blood supply disturbances;
With a progressive transmural type of infarction, as a result of which intestinal damage is widespread.

Depending on the clinical form of the pathology, ischemic colitis can be:

Stenotic or pseudotumorous, in which blood flow disturbances are constant, while inflammation rapidly progresses, causing scarring of the intestinal walls;
Transient, in which vascular blood flow may not be disrupted, but pathological processes still lead to the development of inflammation, which resolves over time;
Gangrenous is the most dangerous and severe form of colitis, in which damage affects all intestinal layers. This form often leads to the development of serious complications.

Symptoms of ischemic colitis

Characteristic manifestations of intestinal colitis are attacks of vomiting and diarrhea, bloating and frequent cramp-like pain in the abdomen.

Patients are worried about headaches or bleeding, dizziness and hypersweating, insomnia. Patients with ischemic inflammation of the intestine experience noticeable weight loss due to digestive disorders.

The most characteristic sign of such colitis is severe pain in the abdomen, which can bother you for two to three hours. The tenderness is usually localized to the left side, although the exact location of the pain depends on the location of the lesion.

The pain syndrome has different characters; it can be paroxysmal or long-lasting and aching. To avoid the occurrence of such painful attacks, it is necessary to follow a dietary diet, giving up spicy, excessively hot or cold foods, as well as dairy products.

In particularly difficult cases, the mesenteric artery becomes blocked, which leads to the development of gangrene.

A similar complication is indicated by the appearance of an acute pain attack in the left abdomen, intestinal obstruction, peritonitis, etc.

When you feel muscle tension and severe pain. If the patient has cardiovascular pathologies, a gangrenous complication can provoke the death of the patient. Therefore, timely diagnosis is important, which will help prevent gangrenous complications.

Diagnostics

To accurately determine the diagnosis and prescribe effective treatment to the patient, a thorough diagnosis is necessary.

A complete analysis of the patient’s complaints is carried out, and a picture of the pathology is drawn up based on the symptoms. The doctor assesses the general condition of the patient, measures temperature and blood pressure.

Laboratory blood tests are prescribed, the degree of blood clotting is determined, the lipid component is identified, etc. A stool examination is also carried out to identify bloody impurities, indicating serious damage to the digestive system.

Endoscopic and x-ray examinations are also carried out. It is important to conduct an electrocardiogram on the patient to assess the performance of cardiac structures. A colonoscopy is also performed, and helps to identify the exact nature of the pathology and prescribe the correct therapy.

Treatment

Against the background of ischemic inflammation of the intestine, patients, as a rule, develop myocardial failure, which occurs as a result of spastic contractions and disturbances in the patency of the intestinal walls. Therapy is complex:

Drugs from the group of vasodilators are prescribed;
The use of sulfonamides is indicated;
In order to enrich the blood with oxygen, oxygen intake is indicated;
To eliminate the inflammatory process, NSAIDs are indicated;
Excessive blood loss requires blood transfusion;
To restore water-electrolyte balance in intestinal tissues, detoxification treatment is indicated.

The intestine, affected by inflammatory processes, needs rest, so patients take nutrition through the parenteral route. If a bacterial infection joins the inflammatory process, then mandatory antibiotic therapy with penicillin drugs is indicated.

If gangrene or necrosis, peritonitis or perforation develops, emergency surgery is indicated.

Additional vitamin therapy (vitamin B and C), taking iron-containing medications are also indicated, and analgesics are needed to relieve pain symptoms.

The patient's diet requires special attention. In the initial stages of the pathological process, it is recommended to eat foods containing fiber.

If the condition is complicated by severe diarrhea, then it is recommended to exclude milk and cucumbers, peas and cabbage. If the patient is concerned about constipation, then it is necessary to introduce stool-laxative foods into the diet, as well as take vascular and laxative medications to normalize intestinal motility and restore microcirculatory processes.

Ischemic intestinal inflammation requires etiotropic therapy. If the pathology is accompanied by infectious lesions, then it is necessary to prevent the development of dehydration, so patients need to take Oralit, Regidron and adsorbents such as white clay or activated carbon.

If necessary, taking cardiovascular medications is indicated. Signs of hyperthermia require antibiotics. With the rapid development of the clinical picture of colitis, drug therapy may be useless. In such a case, surgical removal of the affected areas of the intestine is prescribed.

Complications

If the patient does not seek help from specialists and starts the pathological process, then complications cannot be avoided.

Most often they are associated with rectal bleeding or intestinal obstruction, peritonitis or perforation of the intestinal walls.

The prognosis of the pathology depends entirely on the degree of development of complications and the stage of development of the inflammatory process in the intestine.

In the absence of necrosis and complete restoration of blood flow, the prognostic picture is favorable and the pathology can be cured.

But if ischemic colitis is accompanied by extensive necrotic lesions, and the pathology has developed to an advanced stage or is complicated by atherosclerosis or myocardial failure, then surgical treatment is necessary, the outcome of which is quite difficult to predict. In such a situation, the rehabilitation of the patient will be crucial.

Prevention

If the patient is at risk of developing ischemic inflammatory bowel disease, then it is necessary to exclude all factors that provoke the development of pathology.

An integral part of prevention is a therapeutic diet, which involves limiting fried, spicy, fatty foods. Instead of animal fats, it is better to consume vegetable fats. Alcohol, coffee, ice cream and mustard, various pickled preparations, fatty meats, baked goods and eggs are prohibited.

Ischemic colitis often occurs against the background of atherosclerotic lesions, myocardial insufficiency, surgical operations on the intestines, pelvic organs or stomach, so prevention requires competent treatment of primary pathologies. You also need to dose out physical activity, undergo annual medical examinations and carry out immune-strengthening measures.

Nowadays medicine knows many diseases. Often people are affected by ailments that are associated with the digestive system. One of these is ischemic colitis.

What is this disease and can it be cured?

General information about the disease and the reasons for its development

Ischemic colitis refers to a disease that leads to impaired circulation in the vascular tubules of the large intestine. If there are difficulties with the movement of blood, the affected area experiences a lack of blood, which leads to a deterioration in its functionality and damage to the mucous membrane.

Inflammatory processes often develop in the affected area, which directly affect immune function. Dysbacteriosis and other serious diseases develop.

Ischemic colitis can manifest itself for a variety of reasons, but experts identify the most common ones as:

atherosclerosis of the vascular system, where deposition of fat is observed;
decreased blood flow in the intestinal canal;
formation of blood clots in the vessels;
development of the inflammatory process in the intestinal vessels;
deterioration of blood clotting;
aortic dissection;
sickle cell anemia;
liver transplantation;
obstruction of the intestinal canal;
the occurrence of tumor formations;
the presence of idiopathic colitis.

In this case, ischemic colitis is divided into several subtypes:

reversible. Blood flow in the vascular system is not often disrupted. But as a result of this process, inflammation occurs, which then goes away;
stenosing with irreversible changes. The blood flow is disrupted and this is permanent. The abnormal process is progressing more and more every day. Because of this, scars form on the intestinal walls;
gangrenous. This type of illness is considered the most serious and dangerous not only for the patient’s health, but also for his life. All wall layers are affected.

Ischemic colitis also occurs:

acute;
of a chronic nature.

Intestines can lead to partial or complete tissue necrosis. The chronic disease occurs with mild symptoms.

In advanced situations, narrowing of the lumens in the vessels is observed.

Symptoms

Signs of intestinal ischemia do not appear immediately. At first they are mild in nature. The disease develops very slowly.

If the patient has ischemic colitis, symptoms will manifest themselves in:

painful sensations in the abdominal area. They appear especially clearly after eating food, fifteen to twenty minutes later, and their duration ranges from one to three hours;
decreased appetite, bloating, nausea, belching of air or food;
difficulties with stool. Constipation, diarrhea, or their alternation with each other may occur;
rapid weight loss. This process is caused by poor absorption of food;
development of bleeding from the rectum. This phenomenon manifests itself against the background of erosions and ulcers that have formed on the mucous membrane;
tension of the peritoneal walls, irritation of muscle structures. When palpating, the patient complains of severe pain and increased sensitivity.

In addition, the patient may experience dizziness, disruption of sleep and rest patterns, pain in the head, increased temperature, chills and increased sweating.

In older people, blood pressure may fluctuate, weakness and tremors may occur.

If such symptoms persist for more than six hours, then the doctor may suspect the development of necrosis of the intestinal canal.

Diagnosis

Symptoms and treatment of the disease should be determined as soon as possible. When the first signs appear, you must urgently contact a specialist.

The doctor will listen to the patient's complaints and palpate the abdomen. The doctor will also try to analyze the development of the disease. Perhaps it occurred due to poor nutrition or congestion of the intestinal canal.

Particular attention is paid to the anamnesis. The doctor is trying to find out whether the patient has previously had difficulties with the digestive system, whether there are neoplasms, whether surgical interventions have been performed and whether medications have been used for a long time.

After this, temperature and pressure are measured. This diagnostic method will allow you to assess the severity of the disease.

At the same time, a general examination of the patient is performed. This will allow you to recognize the presence of other problems such as anemia, blood loss and difficulties with metabolic processes.

To confirm the diagnosis, the patient is prescribed a laboratory test.

The patient needs to donate blood, which is used to determine the level of hemoglobin, leukocytes, and ESR. These values make it possible to recognize hidden anemia, iron deficiency, and inflammatory process. The blood test also reveals blood clotting, serum composition, and the ratio of fat cellular structures.

After this, a urine test is performed. This method of diagnosis will help to see impaired kidney function and the presence of infectious agents.

Feces are checked for the presence of mucus, pus and blood streaks. This may indicate certain disorders such as the presence of erosions and ulcers, infectious agents, and dysbacteriosis.

Diagnosis is never complete without instrumental techniques. For ischemic colitis, electrocardiography of the heart muscle and ultrasound diagnosis of the abdominal cavity and aorta are performed.

Additional research methods may be prescribed:

laparoscopy;
Doppler examination of blood vessels in the abdominal cavity;
functional tests;
X-ray examination using a contrast agent.

All these diagnostic methods make it possible to identify the presence of the disease and the stage of its development.

Therapeutic measures for the disease

Treatment of the intestinal canal is based on three basic rules: drug therapy, strict diet and bed rest.

If ischemic colitis develops against the background of another disease, treatment includes symptomatic therapy, but in this case more attention is paid to the root cause.

The duration of the treatment course is determined based on the condition and age of the patient. The older the person, the more difficult it is to treat the disease.

Treatment options include:

normalization of hyper- and dyslipidemia. This will stop the development of atherosclerosis;
taking medications whose effects are aimed at reducing blood viscosity. This will avoid the formation of clots and the development of thrombosis;
use of medications with a vasoconstrictor nature;
use of hypoglycemic drugs;
use of nitrates. They make it possible to relieve pain;
carrying out symptomatic therapy. In case of pain, the patient is advised to take No-Shpu, and in case of high temperatures - antipyretic drugs;
taking enzyme medications;
the use of essential phospholipids;
normalization of weight.

In more advanced cases, the patient undergoes surgery to remove the affected area in the large intestine.

Diet

With ischemic colitis, it is very important to normalize nutrition. A patient with this disease should avoid diarrhea, constipation, and dysbacteriosis. Therefore, diet number five is prescribed.

It implies the exclusion of products in the form of:

pickled products;
sweet products;
soups with meat and mushroom broth;
fatty foods and lard;
fried eggs;
radishes, green onions and spinach;
hot seasonings;
chocolate and other sweets;
alcoholic drinks;
cocoa and black coffee.

For ischemic colitis, the diet should include:

drinks in the form of fruit drinks, compotes, jelly, tea;
eggs. Moreover, their number should not exceed one per day;
bread made from wheat and rye flour;
vegetable, olive or linseed oil;
low fat cottage cheese;
low-fat cheese;
porridge on water in the form of buckwheat, rice, millet, oatmeal;
greenery;
vegetables and baked fruits;
vegetable broth soups;
lean meat. Young veal, turkey, rabbit and chicken are most suitable.

You should eat in small portions five to six times a day. In this case, breaks between meals should be approximately two to three hours.

It is also necessary to devote all efforts to strengthening immune function. To do this, you periodically need to drink vitamin complexes and immunomodulatory agents.

Complications

In the absence of timely treatment, the disease gradually becomes advanced.

If you do not pay attention to the symptoms that appear, the patient may develop complications in the form of:

intestinal obstruction;
perforation of the intestinal canal;
rupture of the walls of the intestinal canal and infection of the abdominal cavity;
toxic megacolon;
massive bleeding;
anemia and iron deficiency;
anorexia.

These processes require urgent assistance from specialists. If the intestinal cavity is damaged, surgical intervention is performed.

In the absence of medical assistance, the patient will die.

Preventive measures

To prevent the development or re-exacerbation of the disease, it is necessary to follow some preventive recommendations:

Nutrition must be correct. You should not consume alcoholic beverages, fast foods and processed foods.
Monitor the condition of the intestinal canal. Avoid diarrhea, constipation and dysbacteriosis.
Include moderate physical activity. You should exercise every morning.
Walk more in the fresh air.
Normalize sleep and rest.
Boost immune function.

Ischemic colitis is a serious disease that requires a strict regimen from the patient. The disease can develop at any age. At the same time, the disease is dangerous due to its complications. Therefore, you should not delay your visit to the doctor.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2017

Chronic vascular diseases (K55.1)

Pediatric Gastroenterology, Pediatrics

general information

Short description

Approved by the Joint Commission on the Quality of Healthcare Services
Ministry of Health of the Republic of Kazakhstan
dated November 28, 2017
Protocol No. 33

Ischemic colitis- inflammation of the mucous membrane of the colon, resulting from impaired blood circulation in the vessels of the mesentery of the colon and includes nosological forms that are the end result of insufficient blood supply to a segment of the colon or the entire colon.

INTRODUCTORY PART

ICD-10 code(s):

Date of protocol development/revision: 2017

Abbreviations used in the protocol:

ALT	-	alanine aminotransferase
AST	-	aspartate aminotransferase
UPS	-	Congenital heart defect
DB	-	children Hospital
XO	-	surgery department
CT	-	CT scan
ICD	-	urolithiasis disease
UAC	-	general blood analysis
OAM	-	general urine analysis
PPP	-	total parenteral nutrition
RDC	-	Republican Diagnostic Center
CO	-	mucous membrane
ESR		erythrocyte sedimentation rate
Ultrasound OBP	-	ultrasound examination of the abdominal organs
Ultrasound OMT	-	ultrasound examination of the pelvic organs
USDG	-	Doppler ultrasound
FCC	-	fibrocolonoscopy
FEGDS	-	fibroesophagogastroduodenoscopy
Emergency	-	celiac trunk
EP	-	enteral nutrition
ECG	-	electrocardiogram

Protocol users: paramedics, emergency doctors, general practitioners, pediatricians, pediatric gastroenterologists, pediatric surgeons.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	High-quality (++) systematic review of cohort or case-control studies, or High-quality (++) cohort or case-control studies with very low risk of bias, or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with a low risk of bias (+), the results of which can be generalized to the relevant population or RCT with a very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the relevant population.
D	Case series or uncontrolled study or expert opinion.
GPP	Best Clinical Practice

Classification

Classification of chronic mesenteric ischemia:

· Stage I- stage of relative compensation. Dysfunction of the gastrointestinal tract is minor, and the disease is often detected by chance, when examining patients for some other reason.
· Stage II- characterized by severe intestinal dysfunction and abdominal pain after eating.
· Stage III- manifested by impaired intestinal function, constant abdominal pain, and progressive weight loss.
Marston classification identifies the following stages of development of intestinal ischemia:
· 0 - normal state;
· I - compensatory damage to the arteries, in which there is no disturbance of blood flow at rest and after eating and there are no symptoms;
· II - arterial damage progresses to such an extent that blood flow at rest remains normal, but reactive hyperemia is absent (as evidenced by pain after eating);
· III - insufficiency of blood supply with a decrease in blood flow at rest; a condition similar to pain at rest during limb ischemia;
· IV - intestinal infarction.

Classification of the development of chronic ischemic disease of the digestive organs (HIBOP):
· I- compensation stage:
- IA - asymptomatic stage; Ultrasound reveals local changes in hemodynamics;
- IB - stage of microsymptoms; the occurrence of ischemic syndrome due to functional overload is observed (local hemodynamic disturbances develop with a tendency to reduce the level of functional and collateral compensation).
· II- subcompensation stage. Ischemia occurs due to the functional load on the digestive organs. Using ultrasound, local hemodynamic changes with various vascular lesions are detected. When eating food, there is no hyperemic reaction or it is paradoxical.
· III - stage of decompensation. Ultrasound diagnoses various lesions of the vessels of the abdominal cavity with the development of local and systemic hemodynamic disorders with a pronounced decrease in the level of functional and collateral compensation.
· IV- stage of ulcerative-necrotic changes in the digestive organs. Ultrasound diagnoses various lesions of the vessels of the abdominal cavity with the development of local and systemic hemodynamic disturbances and the absence of functional and collateral compensation.

Clinical classification of ischemic colitis (considered the most acceptable at the moment):
reversible ischemic colonopathy;
· transient ulcerative ischemic colitis;
· chronic ulcerative ischemic colitis;
colon stricture;
Gangrene of the colon.

Diagnostics

DIAGNOSTIC METHODS, APPROACHES AND PROCEDURES

Diagnostic criteria

Complaints:
· cramping pain after eating;
· tenesmus;
· hematochezia;
· dyspesia
· loss of body weight;
Sitophobia (fear of food or the consequences of eating it);
· diarrhea;
· flatulence;
· pronounced rumbling in the stomach;
· periodic bloating;
· unstable stool (alternating diarrhea and constipation);
· discharge of mucus (from the anus, in stool), after an attack of pain;
· fever;
· tachycardia.

N.B.! Abdominal pain syndrome.
Pain after eating is main symptom ischemic colitis. The nature of the pain is different: in the initial stage of the disease, the pain is equivalent to a feeling of heaviness in the epigastrium, then, aching pain, the intensity of which gradually increases.

N.B.! Typical pain characteristics:
· pain occurs or intensifies after eating (postprandial pain);
· occurs 20-40 minutes after eating (sometimes up to 3 hours);
· the factor that increases pain is not the composition of food, but the quantity;
· pain is associated with physical activity or an attack of angina pectoris;
· depending on the area of blood supply, pain can be localized in different areas (right-sided pain, pain near the navel, pain in the upper abdomen are characteristic of ischemia of the superior mesenteric artery, pain in the left half of the abdomen is characteristic of ischemia in the basin of the inferior mesenteric artery);
· with segmental ischemia, pain may migrate or be vague;
· sometimes resembles coronary pain or pain with intermittent claudication and is associated with the functional activity of the intestines caused by digestive processes;

Bowel dysfunction:
· manifested by a violation of the secretory and absorption functions of the small intestine (flatulence, unstable stools, frequent loose stools), as well as a violation of the evacuation function of the large intestine with persistent constipation.

Progressive weight loss:
· a frequent symptom of chronic ischemia of the digestive organs;
· weight loss is associated with patients’ refusal to eat due to pain, as well as with disruption of the secretory and absorption functions of the small intestine, especially in the late stage of the disease.

Bleeding from the lower intestine:
· episodes of hidden blood loss can last from a day to several months, which aggravates anemia resulting from malnutrition; bleeding in 85% of cases is minor and in 90% stops on its own.

Anamnesis:
· the presence of cardiovascular diseases, obliterating endarteritis, metabolic syndrome in obesity, diabetes mellitus in children and adolescents;
· in children under 18 years of age, the cause of IR may be the use of drugs and certain pharmacological agents (most often: contraceptives).

Physical examination:
Physical examination reveals:
· signs of malnutrition;
· on palpation - pain along the intestine, disproportionate to the efforts.
· pathognomic sign - auscultation - systolic murmur, with damage to the abdominal aotra or celiac trunk (CS) 2-4 cm below the xiphoid process in the midline;
mild, diffuse pain in one area or another of the abdomen;
· characterized by the absence of symptoms of peritoneal irritation (protective, protective symptoms);
· sometimes there may be symptoms of peritoneal irritation;
· presence of systolic murmur in the epigastric region;
· signs of atherosclerotic damage to peripheral vessels (murmurs over the carotid artery, changes in pulse, signs of vascular ischemia in the legs, signs of cerebral ischemia, coronary heart disease).

Laboratory research:
· general blood analysis: anemia, leukopenia, lymphopenia due to chronic malnutrition and/or chronic blood loss.
· biochemical analysis blood: deviations in the content of electrolytes in plasma, hypoalbuminemia, deficiency of fat-soluble vitamins (K, E, D, A).
· coagulogram: as a rule (if the patient is not taking anticoagulants), moderate signs of hypercoagulability are detected. Severe signs of hypercoagulation indicate the acute phase of vascular damage to the intestine. In this case, studies should be supplemented by determining the level of antithrombin III, proteins C and S, dimers and other tests to identify possible DIC or acute thrombosis.
· coprogram: Possible steatorrhea, blood in the stool.
Instrumental studies:
· Ultrasound OBP: At the initial stage, intestinal ischemia may show increased peristalsis, which then normalizes. The intestinal walls become thickened and nodular. Foci of hemorrhage and edema lead to the identification of area(s) of reduced echogenicity in the intestinal wall.
· USDG abdominal aorta and its branches.
· Survey radiography abdominal cavity in a lying and standing position: increased content of gases in the loops of the colon, thickening and rigidity of the wall of the colon, separation of the intestinal loops, the “thumb print” symptom (filling defects) - an early sign, the presence of slit-like areas of clearing between the contrast agent and the walls intestines (segmental spasm of ischemic areas of the intestine), segmental stenoses.

Indications for consultation with specialists:
· consultation with a pediatric neurologist - to exclude neurological diseases;
· consultation with a pediatric anesthesiologist - identification and exclusion of possible contraindications for operations;
· consultation with a pediatric nutritionist - to prescribe a diet and select enteral nutritional formulas after surgery;
· consultation with a pediatric TB specialist - to exclude a specific tuberculosis process in the intestine;
· consultation with a pediatric urologist - to exclude urinary tract diseases;
· consultation with a pediatric cardiologist - in case of unstable cardiodynamics;
· consultation with a pediatric infectious disease specialist - to exclude infectious intestinal diseases;
· consultation with a pediatric gynecologist - to exclude adnexitis and other gynecological diseases;
· consultation with a pediatric hematologist - in case of development of hematological complications;
· consultation with a psychiatrist - for the correction of acute mental disorders;
· consultation with a psychologist - for the correction of psychological disorders;
· consultation with a pediatric oncologist - to exclude an oncological process in the intestines;
· consultation with a morphologist - to conduct a histological examination of the intestinal mucosa.

Diagnostic algorithm:

Differential diagnosis

Differential diagnosis and rationale for additional studies:

*Diagnosis*	*Rationale for differential diagnosis*	*Surveys*	*Diagnosis exclusion criteria*
Ulcerative colitis in children	Gradual start	UAC FEGDS FCS with biopsy intestinal circulatory system	-FCS - continuous lesion of the colon - erosions and/or ulcers in the large intestine, rectum Formation of strictures is not typical -During radiography, “Finger indentations” on radiographs are very rare Histology - crypt abscesses
Crohn's disease in children	Gradual onset of pregnancy until changes in the intestinal mucosa appear Often aphthous stomatitis, Localization of pain · presence of anal and perianal lesions - fissures, fistulas	UAC FEGDS FCC with biopsy intestinal circulatory system	-UAC high ESR, leukocytosis, anemia P - FGDS reveals changes in gastric mucosa in the form of “cobblestone pavement”; . FKS - intermittent lesions and ulcers . terminal ileitis, right half of the colon, total colitis . formation of strictures is typical . - During radiography, “Finger indentations” are not typical on radiographs . Histology - sarcoid granulomas
Colon cancer in children	Abdominal pain Bloody stool Weight loss	FCS with intestinal biopsy	. With FCS, detection of formations in the large intestine . Histological changes in the intestine - cancer, adenocarcinoma
Diverticular disease in children	. Nausea . Repeated vomiting . Increasing intoxication . Bloody feces	. FCC	. FCS reveals intestinal diverticula . Laparoscopy reveals . intestinal diverticula
Intestinal obstruction in children	. Paroxysmal abdominal pain . Nausea . Vomit Bloating · Belly · Lack of stool	. Diagnostic laparoscopy . FCC	. Irrigoscopy with X-ray contrast agent . Diagnostic laparoscopy - intestinal obstruction . FCC
Adhesive intestinal obstruction (after surgery for acute appendicitis, abdominal trauma)	. Paroxysmal pain in the abdomen (the patient cannot find a place to rest) . Abdominal asymmetry . Nausea . Smell from the mouth . Repeated vomiting (fecal vomiting) · Bloating Increased infrequent peristaltic contractions . lack of stool	. X-ray of intestines . laparoscopy	. X-rays reveal clear horizontal levels (Kloiber cups), “arches” in sharply distended loops of the small intestine. . X-ray reveals multiple horizontal levels and gas bubbles in moderately distended intestinal loops. . Laparoscopy - detection of adhesive intestinal obstruction
Cystitis in children	lower abdominal pain	Ultrasound of the bladder OAM, UAC	. Ultrasound of the bladder signs of inflammation . Signs of inflammation in blood and urine
ICD in children	Sharp pain in the abdomen	IV urography	. Detection of stones in the kidneys and ureters
Inflammation of the uterine appendages (adnexitis) in girls	Sharp pain in the abdomen Malaise Temperature increase Local symptoms - pain and leucorrhoea - discharge	Examination by a pediatric gynecologist UAC Bacterial culture of secretions Ultrasound OMT	Inflammation of the uterine appendages

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Ischemic colitis is an inflammation of the colon caused by damage to the blood vessels. When the disease becomes chronic, serious pathological complications often appear.

Paid gastroenterologists at the UNION CLINIC medical center are among the best specialists in St. Petersburg. Highly qualified doctors, extensive clinical experience and modern medical equipment of our center allow us to successfully diagnose and treat numerous diseases of the gastrointestinal tract, including ischemic colitis.

If signs of colitis appear, our experts recommend immediately seeking medical help. The specialized gastroenterology department of our clinic sees patients every day.

Reasons for the development of the disease

venous thrombosis;
atherosclerosis;
embolism;
heart failure;
blockage or damage to arteries and small vessels due to rheumatoid arthritis, diabetes, surgery, or injury;
congenital anomaly of the celiac trunk.

Ischemic colitis is a very dangerous inflammatory disease, which without appropriate treatment can even lead to death. The cause of its appearance may be a combination of chronic pathologies of the cardiovascular system and damage to the blood vessels of the abdominal cavity. The following symptoms may appear:

intestinal dispersion;
sudden and systematic paroxysmal pain in the abdominal area;
bleeding in the intestines;
nausea and vomiting;
stool disorder;
the presence of mucus and blood in the stool.

In the early stages, the disease can be completely asymptomatic.

Diagnosis and treatment of ischemic colitis

Before starting direct treatment of the disease, doctors at the UNION CLINIC medical center conduct a comprehensive diagnosis. It may include the following studies:

irrigoscopy;
Ultrasound of the abdominal cavity;
endoscopic examination;
laboratory tests of blood and stool.

If necessary, additional diagnostic procedures may be prescribed.

Modern equipment and innovative diagnostic methods allow you to quickly obtain reliable research results and, based on them, make an accurate diagnosis. This greatly simplifies the treatment of various gastrointestinal diseases (flatulence, ulcers, dysbacteriosis, etc.).

When ischemic colitis is detected, doctors at our clinic develop an individual diet for patients and select the optimal therapy. At later stages of pathology development, blood transfusion, parenteral nutrition and normalization of water and electrolyte balance may be necessary. In the presence of concomitant infectious diseases, a course of drug therapy is carried out.

Surgical intervention is used only for the treatment of advanced colitis, characterized by necrotic processes. In this case, the affected area of the intestine is completely removed.

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Chronic inflammation and diseases of the colon are among the most difficult areas of gastroenterology. Together with ulcers, infectious colitis, Crohn's disease, microscopic and ischemic colitis have become widespread.

Ischemic colitis is an inflammation of the colon as a result of the development of its ischemia, that is, an acute or chronic disruption of the blood supply to its mucous membrane.

Blood enters the large intestine from the inferior and superior mesenteric arteries. The superior artery supplies nutrients to the ascending, colon, and cecum, and the inferior artery supplies blood to the left side of the intestine. With intestinal ischemia, bacteria and microbes of pathogenic microflora that live inside it are activated, resulting in inflammation of the mucous membrane.

Often the disease affects the flexure of the spleen and the left intestine.

causes of ischemic colitis

In fact, there are many reasons for the development of this disease.

These include:

atherosclerosis of the inferior or superior mesenteric artery (mesenteric);
compression of blood vessels;
the appearance of a tumor formation;
the presence of adhesions;
enlarged lymph nodes;
defects in vascular development;
development of microspherocytic anemia;
fibromuscular type dysplasia;
damage to the inner lining of the heart as a result of infection;
inflammation of the walls of blood vessels (vasculitis);
joint inflammation (arthritis);
inflammation of the veins and arteries (Buerger's disease, panarteritis);
vascular disease (aortoarteritis);
development of allergic reactions;
operations on abdominal aneurysm;
gynecological operations;
transfusion of blood incompatible with the patient’s blood group;
operations on the stomach and intestines;
poor nutrition, poisoning.

A common cause of the disease is impaired blood flow, which occurs when
blockage of a small artery, it supplies blood to a certain part of this internal organ.

In its course, inflammation can be acute or chronic. The acute form is characterized by severe pain that is temporary, attacks of nausea and vomiting, bleeding, and fever. The chronic form of ischemic colitis is expressed in constant pain in the abdomen, stool disturbances, vomiting, frequent nausea, belching, weakness, sleep disturbances, and weight loss. The affected part of the intestine narrows. Chronic colitis can last a lifetime and must be periodically treated with medications.

Symptoms of ischemic colitis

The first thing that occurs is pain in the abdominal area. The pain appears half an hour after eating and lasts more than an hour. It is most felt in the left side of the abdomen and iliac region or in the area of the flexure of the spleen, maybe near the navel. If fibrous strictures develop in the intestines, the pain is constant.

In this case, dyspeptic disorders appear:

appetite suppression;
attacks of nausea, vomiting;
severe bloating and cramps after eating;
diarrhea and constipation.

When the disease worsens, a person more often suffers from loose stools. Because of the pain, the desire to eat decreases, as a result, the process of absorption of nutrients is disrupted, and the patient begins to lose weight. Tenesmus appears - false sensations of the need to go to the toilet. Most patients experience bleeding inside the colon, which can vary in intensity, from a small amount in the stool to severe bleeding in the rectum.

Bleeding occurs as a result of the appearance of erosions and ulcers on the mucous membrane. During an exacerbation, the abdomen takes on an acute shape and becomes very tense. On palpation, pain is noted in its left side and iliac region, as well as diffuse sensitivity.

If the blood flow is disrupted due to narrowing of the artery or its spasm, then there is a high risk of a lack of blood supply, then the mucous and muscular membranes are affected. Fibrous stenosis occurs. If the ischemia is minor, then the mucous membrane is not significantly damaged. If large vessels of the peritoneum become clogged, necrosis of the organ walls develops, followed by inflammation of the peritoneum.

The stage of “pouches” in the development of ischemic colitis is a late sign of irrigoscopic examination. If you experience pain in the abdomen, bleeding and diarrhea with blood discharge, you should immediately consult a doctor to undergo irrigoscopy.

An important radiological sign of IBTK is a symptom "thumbprint". It is manifested by the presence of round defects (sacs) in the wall; they appear due to hemorrhages in the submucosal layer. If the form of inflammation is reversible, then these bags dissolve on their own in a few days or hours.

If the stage of the disease is more severe, then the mucous membrane is rejected over the area where the hemorrhage occurred, eventually forming an ulcer.

What most often affects the disease called ischemic colitis, which organs suffer more? The vulnerable affected area is the splenic flexure of the colon. The disease also affects the left flexure of the sigmoid colon. As a result of impaired blood flow, erosions and ulcers most often form on the wall.

diagnosis of ischemic colitis

Inflammation often develops in people over 60 years of age. The doctor examines the patient using palpation and auscultation. When palpating the abdomen, the patient complains of pain in the left part of the peritoneum and left hypochondrium. A dense aorta can be felt in the mesogastric region, which hurts and pulsates strongly. When listening, a systolic murmur is heard near the xiphoid process.

Diagnostics also includes a biochemical blood test, which shows the level of protein, albumin and iron. Colonoscopy is done after acute symptoms have subsided. With its help, you can detect hemorrhagic lesions in the mucosa and submucosal layer, ulcers, strictures, and areas of edema.

An abdominal x-ray shows air content in the angle of the spleen. A decrease in the lumen of the arteries can be determined using Doppler ultrasonography and angiography. A biopsy of mucosal tissue allows for histological verification of the lesion and its extent. Timely diagnosis allows you to prescribe the correct treatment, which will help avoid serious complications of the disease.

Treatment of ischemic colitis

With the initial development of inflammation, the patient must follow a certain diet, taking into account what disorders he has in the process of digesting food. You need to eat small meals, 5-6 times a day, in small portions. Eliminate everything fried, spicy, pickled, smoked, and fatty. So, for constipation, you need to eat foods containing a lot of fiber, laxatives are prescribed, and if you have loose stools, you should refrain from peas, cucumbers, cabbage, milk, and antidiarrheals are prescribed.

Treatment includes taking various medications depending on the severity of symptoms. The administration of glucocorticosteroids during the inflammatory process is contraindicated because they may prevent the doctor from seeing the real picture of organ perforation.

In most cases, if there is an ulcer on the mucous membrane, there is a small amount of blood that enters the organ, as well as discharge in the stool. They go away on their own some time after the pain disappears and the mucous membrane heals. The recovery period may take from 2 to 4 weeks.