Search

The records of 27 patients with colonic ischemia were reviewed. Twelve patients had typical reversible or transient ischemic colitis. Thirteen patients had an ischemic stricture or gangrene of the colon that required operation. Two of the patients have asymptomatic strictures of the splenic flexure and are under observation. The sigmoid colon in our series of patients was the most frequent area of symptomatic stricture formation. Any patient with ischemic colitis, especially that involving the sigmoid colon, should be observed closely for the development of a stricture. Surgical intervention is indicated only after colonoscopy and careful evaluation of symptoms and risk factors.

Vascular ectasias are an acquired type of arteriovenous malformation distinct from neoplastic and congenital lesions. They can be the source of occult, recurrent or massive colonic bleeding usually in elderly patients but, occasionally, in younger adults. The vascular lesions are usually small but can be quite diffuse. The majority occurs in the right colon, but in our group of patients, a substantial number occurred distal to the hepatic flexure. The diagnosis can be made preoperatively, with colonoscopy but, more consistently, with arteriography. Therefore, arteriography should be performed in any patient with bleeding of the colon before surgical intervention. We recommend resection of the involved segment of the intestine as the treatment of choice.