Cappell M S
Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
Gastroenterol Clin North Am. 1998 Dec;27(4):827-60, vi. doi: 10.1016/s0889-8553(05)70034-0.
Ischemic colitis accounts for approximately half of all cases of mesenteric vasculopathy. The clinical presentation varies depending on underlying cause, extent of vascular obstruction, rapidity of ischemic insult, degree of collateral circulation, and presence of comorbidity. Ischemic colitis is usually diagnosed by colonoscopy. Only approximately 20% of patients require surgery because of signs or laboratory findings of peritonitis or because of clinical deterioration. Approximately 20% of patients develop chronic colitis from irreversible colonic ischemic injury, which manifests clinically as persistent diarrhea, rectal bleeding, or weight loss and endoscopically as a colonic stricture or mass. Chronic mesenteric ischemia is almost always caused by significant atherosclerotic stenosis involving at least two mesenteric arteries, usually the superior mesenteric artery and celiac axis. The classic symptomatic triad of postprandial pain, fear of eating, and involuntary weight loss occurs with advanced disease.
缺血性结肠炎约占肠系膜血管病变所有病例的一半。临床表现因潜在病因、血管阻塞程度、缺血损伤的速度、侧支循环程度以及合并症的存在而有所不同。缺血性结肠炎通常通过结肠镜检查来诊断。仅约20%的患者因腹膜炎的体征或实验室检查结果或因临床病情恶化而需要手术。约20%的患者因不可逆的结肠缺血损伤而发展为慢性结肠炎，其临床症状表现为持续性腹泻、直肠出血或体重减轻，内镜检查表现为结肠狭窄或肿块。慢性肠系膜缺血几乎总是由至少累及两条肠系膜动脉（通常是肠系膜上动脉和腹腔干）的严重动脉粥样硬化狭窄引起。典型的症状三联征，即餐后疼痛、畏食和非自愿体重减轻，出现在疾病晚期。
