Watanabe M, Hasegawa H, Kitajima M
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1999 May;100(5):347-51.
Ischemic colitis is the most common manifestation of gastrointestinal ischemia. The presumed etiologies are numerous; however, it typically develops spontaneously. It is classified into the transient type, stricture type, and gangrenous type. The majority of patients with ischemic colitis, excluding the gangrenous type, follow a benign clinical course in the absence of major vasculature occlusion. It usually presents as an acute abdominal illness with bloody diarrhea. Diagnosis is confirmed by colonoscopy and/or barium enema. Nongangrenous ischemic colitis usually requires only conservative therapy, including repeated careful assessment, pain control, and fluid replacement, and is associated with a good prognosis. It may lead to the sequela of persistent segmental colitis or colonic strictures, occasionally requiring surgery. Urgent surgery and high morbidity and mortality rates are hallmarks of the gangrenous type. Special consideration must be given to those patients in whom ischemic colitis develops in the context of colon cancer or obstructive colonic lesions. Successful management of a patient with ischemic colitis requires a high degree of clinical suspicion, early diagnosis, careful follow-up, and prompt recognition of persistent disease.
缺血性结肠炎是胃肠道缺血最常见的表现形式。其推测病因众多；然而，它通常是自发发生的。它可分为短暂型、狭窄型和坏疽型。除坏疽型外，大多数缺血性结肠炎患者在无主要血管闭塞的情况下临床病程呈良性。它通常表现为伴有血性腹泻的急性腹部疾病。通过结肠镜检查和/或钡灌肠可确诊。非坏疽性缺血性结肠炎通常仅需保守治疗，包括反复仔细评估、控制疼痛和补充液体，且预后良好。它可能导致持续性节段性结肠炎或结肠狭窄等后遗症，偶尔需要手术治疗。紧急手术以及高发病率和死亡率是坏疽型的特征。对于在结肠癌或梗阻性结肠病变背景下发生缺血性结肠炎的患者必须给予特别关注。成功治疗缺血性结肠炎患者需要高度的临床怀疑、早期诊断、仔细随访以及及时识别持续性疾病。
