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Cytomegalovirus (CMV) causes infections in healthy individuals and compromised hosts. In compromised hosts, CMV may cause encephalitis, pneumonia, hepatitis, colitis, and so forth. In immunocompetent hosts, CMV mononucleosis is the most common clinical manifestation and CMV colitis is rare. We present a case of an 82-year-old immunocompetent man who presented with community-acquired bloody diarrhea. A computed tomography scan of the abdomen revealed pan-colitis. His age and abdominal pains suggested ischemic colitis as the cause of his bloody diarrhea. Workup for Clostridium difficile and all enteric pathogens were negative. The patient remained febrile with abdominal pain. During the second week, he underwent sigmoidoscopy for biopsy, which revealed viral inclusions of the Cowdry owl eye inclusion bodies characteristic of CMV. CMV colitis was diagnosed in the patient; he was successfully treated with a course of oral valganciclovir and made an uneventful recovery.

Ischaemic colitis (IC) is the most frequent form of gastrointestinal ischaemia. Discrepancy between non-specific symptoms and objective findings is a hallmark of IC. Thus delay of diagnosis is common due to its often subtle and unpredictable presentation. In particular, the clinical symptoms and signs of IC can overlap with those of inflammatory bowel disease. We present a case of a young man with known factor-V-Leiden mutation in whom IC developed during effective therapy with oral anticoagulants, presenting with symptoms and endoscopic findings suggestive of inflammatory bowel disease.

Tegaserod, a potent partial agonist of the serotonin 5-HT4 receptor, is used to treat women with constipation-predominant irritable bowel syndrome. Since the drug's approval, the manufacturer has received infrequent although serious reports of diarrhea and ischemic colitis in patients taking the drug. These instances have led to a recent warning letter to physicians and a change in the prescription labeling of tegaserod. We describe the development of ischemic colitis in a woman who was treated with tegaserod and review the relationship among ischemic colitis, tegaserod use, and irritable bowel syndrome. Potential mechanisms involved in the occurrence of ischemic colitis in patients receiving tegaserod are also discussed.

Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.

Background: Intestinal ischaemia is caused by a reduction in intestinal blood flow. This entity is being increasingly recognised as a cause of abdominal symptoms but is often not diagnosed accurately. Chronic mesenteric ischaemia (intestinal angina) refers to chronic post-prandial abdominal pain caused by intestinal hypoperfusion usually related to atherosclerosis. Colonic ischaemia refers to colonic injury as a result of hypoperfusion and is also referred to as ischaemic colitis., Methods: Review of the English-language medical literature, with the key words diagnosis, treatment, chronic mesenteric ischaemia and colonic ischaemia., Conclusion: There is a lack of evidence based on randomised controlled clinical trials for both the diagnosis and treatment of mesenteric ischaemia. A high index of clinical suspicion is important to facilitate rapid diagnosis. Chronic mesenteric ischaemia can be accurately diagnosed by non-invasive CT and MRI techniques, and less so by duplex ultrasound. In order to confirm the diagnosis, demonstration of the involvement of at least two of the main splanchnic vessels is required. Successful treatment involving both percutaneous and surgical revascularisation is available. Colonic ischaemia requires sequential diagnostic techniques and the majority of cases resolve with supportive treatment. More severe cases may require surgical intervention.

Background: The purpose of this study is to analyze the risks vs. the benefits of colonoscopy soon after myocardial infarction., Methods: A total of 100 consecutive patients undergoing colonoscopy within 30 days after myocardial infarction at two large tertiary cardiac referral hospitals were studied. The study group was compared with 100 control patients with neither myocardial infarction nor unstable angina during the preceding 6 months (matched for age, colonoscopy indication, and colonoscopist) who underwent colonoscopy., Results: Indications for colonoscopy were bleeding per rectum (37 patients), fecal occult blood (36 patients, hematocrit < 30% in 25), iron deficiency anemia (11 patients, hematocrit < 25% in 9), and other (16 patients). Colonoscopy was performed at a mean of 15.5 (8.3) days after myocardial infarction. Two patients underwent colonoscopic colonic decompression. Colonoscopy was diagnostic in 46 (47%) of the study patients vs. 41% of the control patients ( p = 0.47, chi-square test). The relative rate of ischemic colitis was significantly higher in study vs. control patients (14 vs. 2, p < 0.005). Other diagnoses in study patients were the following: colon cancer (8), bleeding internal hemorrhoids (5), pseudomembranous colitis (5), high-risk adenomatous polyp (large or villous histopathology) (4), and other (10). Urgent colonoscopy was diagnostic in 63% of cases. Twenty-three patients had a major therapeutic benefit consequent to colonoscopy, including colon cancer surgery in 5. Study patients were significantly sicker than control patients (APACHE II score 9.9 [4.3] vs. 7.4 [2.8], p < 0.0001) and suffered significantly more colonoscopic complications compared with control patients (9 vs. 1; OR 5.2: 95% CI [1.2, 9.8], p < 0.03). Minor complications without clinical sequelae occurred in 8 study patients (asymptomatic hypotension or bradycardia). One major complication occurred in this group that was probably not procedure related., Conclusions: Colonoscopy in patients with a recent myocardial infarction is associated with a higher rate of minor, transient, and primarily cardiovascular complications compared with control patients but is relatively infrequently associated with major complications. Colonoscopy is beneficial and indicated after myocardial infarction, despite a higher risk, in certain circumstances. The relative frequency of ischemic colitis was relatively high in study patients.

A unique case of fibromuscular hyperplasia (FMH) of the visceral vasculature is presented. A 31-yr-old patient presented with a chronic colitis initially diagnosed as ulcerative colitis 1 yr earlier. On presentation, the endoscopic appearance showed deep linear ulcerations and cobblestoning and was more consistent with Crohn's disease. Biopsies of the area, however, suggested an ischemic etiology. The patient failed to respond to local 5ASA and prednisone therapy and progression of the disease led to a left hemicolectomy. A diagnosis of a small vessel fibromuscular arteriopathy was made on the resected specimen. This is the first case presentation of FMH mimicking inflammatory bowel disease. The lack of any systemic involvement of FMH with isolated small vessel disease has never been reported and serves as an index case of which clinicians should be aware. The literature is reviewed and the possible implications are discussed.

We described signs and symptoms of patients who present to an Emergency Department (ED) with intestinal ischemia and compare clinical course and outcomes of patients with mesenteric vs. colonic ischemia. We retrospectively reviewed charts of 100 patients discharged from our hospital with an ICD-9 code for mesenteric or intestinal ischemia. Compared to patients with mesenteric ischemia, those with colonic ischemia were older (61 vs. 77 years, respectively; p = 0.002), were more likely to present with gastrointestinal (GI) bleeding (11 vs. 90%, respectively; p < 0.001), but were less likely to report abdominal pain as their primary complaint (89% vs. 10%, respectively; p < 0.001) or to receive a correct ED diagnosis (75% vs. 9%, respectively; p < 0.001). Patients with colonic ischemia frequently presented with gross GI bleeding, and were often misdiagnosed in the ED. For timely treatment of a potentially serious condition, the diagnosis of intestinal ischemia should be considered in ED patients presenting with GI bleeding and appropriate risk factors.

Ischaemic colitis is the most frequent form of mesenteric ischaemia and is most frequently the result of a non-occlusive disease process. Elderly patients, especially those with underlying co-morbid conditions are at greatest risk. The symptoms are often non-specific and diagnosis is usually established upon the clinical setting and colonoscopy with biopsy. In the majority of cases, ischaemic colitis can be treated non-surgically with a successful outcome.

Purpose: Emergent repair of ruptured abdominal aortic aneurysms (rAAAs) is associated with high perioperative morbidity and mortality. One of the significant complications of this surgery is bowel ischemia. Reports detail mortality as high as 80% when this condition is realized. The objective of this project was to determine both the incidence and the effect of mandatory postoperative colonoscopy on outcome of colon ischemia after rAAA., Methods: From July 1995 to September 2002 all patients with an rAAA who underwent emergent aortic reconstruction were included in this review. All colonoscopies were performed within 48 hours, ischemia was graded consistently, and treatment was initiated per protocol based on grade of ischemia. Patients with grades I and II ischemia were followed up with medical management and repeat colonoscopy. All patients with grade III ischemia underwent bowel resection. Preoperative, intraoperative, and postoperative variables were collected to assess possible independent risk factors for and predictors of bowel ischemia., Results: Eighty-eight patients underwent emergent aortic reconstruction because of rAAA in the study period. Their mean age was 73 years, and 64 patients (72%) were men. Operative mortality was 42%. Eighteen percent of patients died within 24 hours, and 24% died between 1 and 30 days after surgery. Colonoscopy was performed in 62 of 72 patients who survived more than 24 hours. Bowel ischemia was documented in 26 of the 72 patients (36%). Of these, 16 patients had grade I or grade II ischemia at both initial and repeat endoscopy. Nine patients underwent exploratory laparotomy with bowel resection because of grade III ischemia; two procedures were performed because of worsening ischemia discovered at repeat colonoscopy. In patients with colonoscopic findings of bowel ischemia the mortality rate was 50% (13 of 26 patients). In those with grade III necrosis who underwent resection the mortality rate was 55%. Elevated lactate levels, immature white blood cells, and increased fluid sequestration were all variables associated with the occurrence of colon ischemia., Conclusions: Bowel ischemia is a frequent postoperative complication (42%) of repaired rAAA. Performing mandatory surveillance colonoscopy in these patients may be associated with a decrease in overall mortality and improved survival in patients with transmural bowel necrosis with no comorbid condition.

History and Admission Findings: A 49-year-old man was admitted to hospital with lower gastro-intestinal bleeding. He complained of fatigue, weight loss and bloody stools for a few days. There was no history of abdominal pain, but he had irregular bowel movements for some weeks with alternating constipation and diarrhea. He regularly took furosemide and ACE inhibitors for hypertension. The abdominal investigation was unremarkable., Investigations: Laboratory investigations showed a significant anemia (Hb 6,3 g/dl), WBC, C-reactive protein and lactic acid were normal, carcino-embryonic antigen was 38 ng/ml and thus increased (normal value: < 5 ng/ml). Colonoscopy revealed a circular stricturing and ulcerating tumor at 70 cm, which looked highly suspicious for malignancy and could not be passed endoscopically. Biopsies showed high-grade dysplasia and colon contrast x-ray confirmed a stricturing tumor., Treatment and Course: Laparotomy was performed for a bleeding colon carcinoma. However, besides multiple inflammatory-stenosing strictures of different parts of the right colon, no tumor was found. Perfusion of the small and large bowel was normal. A right colectomy was performed and multiple deep ulcerations and strictures were found inside the resected colon. A cecal ulceration was the origin of the bleeding. After stopping furosemide intake no further bleeding or colonic ulceration occurred., Conclusion: This is an unusual case of drug related non-occlusive, ulcerative-stricturing, ischemic colitis, masquerading as colonic cancer. Although diuretic-induced non-occlusive ischemic colitis is a very rare finding, it should be taken into account in young patients with ischemic colitis, when other risk factors have been excluded and intake of diuretics is reported.

Ischemic colitis resulting in colonic infarction after aortic reconstruction is a highly lethal complication. The etiology and pathogenesis of this condition demonstrate that in many instances it may be prevented. Early recognition, particularly of the transmural ischemic injury is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to be inaccurate in terms of predicting colonic ischemia. The purpose of this study is to assess the main monitoring technique for prediction of ischemic colitis during aortic surgery as: colonic mesenteric Doppler signal, inferior mesenteric arteries stump pressure, sigmoidal intramucosal pH and measurement of mucosal capillary haemoglobin oxygen saturation by reflectance spectrophotometry. A 15-year experience with 1912 patients undergoing abdominal aortic reconstruction was reviewed to determined both the incidence of intestinal ischemia and the clinical anatomic, and technical factors associated with this complication of aortic surgery

Purpose: Ischemic colitis is a disease of elderly patients and includes a wide clinical spectrum ranging from mild to severe forms. Some patients may develop complications. Management of this disorder depends on disease severity. Our aim was to review the clinical characteristics of patients diagnosed of ischemic colitis and analyze predictive factors of poor prognosis., Methods: This study is a retrospective analysis of 53 cases of ischemic colitis (33 men, 20 women), 35 with moderate and 18 with severe forms, respectively. Clinical characteristics, diagnostic procedures, segment of colon involved and long-term evolution after discharge were analyzed., Results: Hypertension (51 percent) was the main risk factor associated with ischemic colitis. Clinical presentation did not differ between groups, except for peritonitis which was present only in the severe group. Colonoscopy and histologic studies were the most used diagnostic procedures (90 percent). Peripheral vasculopathy (P < 0.01) and right colonic involvement (P < 0.001) were risk factors for severe outcome. Five patients died during admission. Among these, the right colon was affected in four (80 percent). No patient in either group developed chronic ischemic colitis during follow-up., Conclusion: Ischemic colitis usually runs a benign course after acute colonic insult. Peripheral vasculopathy and right colonic involvement are associated with severe forms of ischemic colitis.

The article presents a study of clinical variants of ischemic lesions of the large intestine (ILLI) in patients with the chronic abdominal ischemia (CAI) syndrome. There was an examination of 42 patients with putative ILLI, who had a cardiovascular pathology at the background, which led to significant hemodynamic disorders of the blood flow in unpaired visceral branches of the abdominal aorta. The authors performed a complex diagnostics of ILLI including anamnestic and clinical data, laboratory and morphological assessment of the large intestine and vessels providing its blood supply. Based on the data collected, other functional and organic diseases of the large intestine (LI) were excluded. It was revealed that the final result of ILLI differed depending on the ischemia degree--from reversible functional disorders to high-grade organic lesions of the LI. Each clinical variant of ILLI has its own clinical manifestations as well as functional, organic and morphological peculiarities of changes in the LI revealed by a laboratory and histological examination of the LI.

Contemporary opinions on etiology and pathogenesis of ischaemic colitis have been presented. Diagnostic difficulties in endoscopic and pathologic examination of colonic ischaemic changes have also been discussed. Some aspects of differential diagnosis of ischaemic colitis has been discussed. The literature opinions and authors own experience indicate that ischaemic colitis is still serious histoclinical problem which could be resolved only if close cooperation of gastrologists and pathologists has been applied.

The colon is the most common site of gastrointestinal ischemia. The condition resolves completely with conservative treatment in most cases, but late diagnosis or severe ischemia can be associated with high rates of complications and death. Once ischemic colitis is diagnosed, serial physical examinations and colonoscopies are helpful to follow the condition. Prompt surgery is required for severe episodes, when conservative measures fail, and for patients with chronic symptoms.

Intestinal hypoperfusion is among the factors implicated in sepsis and multiorgan failure. Splanchnic blood flow may be sacrificed to maintain supply to vital organs, even when hemodynamic alterations are minor. The sensitivity of invasive hemodynamic monitoring for detecting intestinal hypoperfusion is low. This paper aims to review current knowledge about indirect measurement of splanchnic perfusion by way of gastrointestinal tonometry. We review the pathophysiology of ischemic intestinal lesions, the basis for gastrointestinal tonometry, and the method. Finally we discuss clinical applications (early diagnosis of ischemic colitis and ischemia of the flap after esophageal reconstruction, weaning from mechanical ventilation, abdominal compartment syndrome, liver transplant, heart surgery, prognostic factors and care of the critically ill patient). An adequate understanding of this monitoring technique and management of information it provides can give an early warning of the intestinal hypoperfusion that precedes other serious systemic complications.

We describe a young woman whose initial presentation was dominated by acute diarrhoea. Life-threatening multiorgan failure rapidly ensued and necessitated mechanical ventilation and dialysis treatment. An initially elongated activated partial thromboplastin time prompted further coagulation tests that led to the detection of positive lupus anticoagulant, a highly elevated IgG-anticardiolipin (aCL) antibody titre, and prolonged dilute Russell's viper venom time. Histological examination of samples obtained during endoscopy revealed widespread intestinal thrombotic microangiopathy. In view of these serologic and histologic features, a diagnosis of the malignant variant of the antiphospholipid syndrome (APS), also termed 'catastrophic APS', was established. In spite of this syndrome's grim prognosis, the patient recovered following intensive anticoagulation and adjunct treatment with steroids and immunoglobulins.

Intestinal ischaemia typically presents with signs suggestive of an acute surgical abdomen. A raised serum lactate may substantiate the diagnosis. The first case of ischaemic hepatitis mimicking intestinal ischaemia is reported. The recognition of markedly deranged transaminases allows the clinician to differentiate the two diagnoses and potentially avoid the risks incurred with laparotomy.

Unlabelled: Ischemic colitis (IC) is an important clinical problem, and may present after aortic surgical procedures. The aim of this work was to establish risk factors for IC presentation in aortic surgical replacement patients., Material and Methods: A retrospective study of patients with aortic surgical replacement in a 3-year period was carried out. Patients were divided into two groups: patients without IC and patients with IC, the later group subdivided into patients with gangrenous ischemic colitis and without gangrenous ischemic colitis. Multiple logistic regressions was used to obtain the variables for possible risk factor for IC., Results: We included 101 patients in the study; ischemic colitis was present in 16.8% of all cases, with 47.1% of gangrenous type. Metabolic acidosis was the most frequent alteration. Diagnosis was made by endoscopy in 94.1%. Mortality in IC group was 18.2% with an increase in the gangrenous group to 62.5%. Identified risk factors were disrupted aneurysm, previous colonic surgery, emergency surgery, and hemodynamic instability., Conclusions: Ischemic colitis is most frequent in emergency surgery for disrupted aneurysm in the hemodynamically unstable patient with retroperitoneal hematoma. We must entertain a high suspicion index for IC in all patients with aortic surgical procedures for early detection and adequate treatment.

We report a 29 years old male, with a history of cocaine abuse and excessive alcohol intake, who was admitted to the hospital with an acute peritonitis. The patient was operated and multiple perforations of the cecum were found. A right hemicolectomy was performed and the pathological study of the surgical piece showed an ischemic colitis. A literature review reveals 22 reported cases of ischemic colitis associated to cocaine abuse.

A 62-year-old man with grade III ischemia of the legs and occlusion of an aortofemoral shunt underwent axillofemoral bypass and bilateral profundoplasty. During surgery, an aneurysm in the aortic origin of the right common iliac artery ruptured, requiring ligation of the inferior vena cava, the iliac veins and the right common iliac artery. Upon transfer of the patient to the recovery unit, the sigmoid intramucosal pH (pHi) was 6.83 (arterial pH 7.35), the regional CO2 pressure (PrCO2) was 100 mmHg (arterial PCO2 35.2 mmHg), and the lactic acid concentration was 3.6 mmol/L. Ischemic colitis was suspected and colonoscopy confirmed the presence of severe rectal and moderate sigmoid inflammation. An extended sigmoidectomy was performed with colostomy. The patient died from multiorgan failure 48 hours after surgery. Ischemic colitis is a severe complication of aortic surgery. Sigmoid pHi monitoring is non-invasive and highly useful for the early diagnosis of ischemic colitis.

The term colonic ischaemia was first coined approximately 40 years ago. Up until that point, the disease was only diagnosed in cases where the colon was completely gangrenous. In the 1960s reversible non-transmural ischaemia of the colon was described and much has been written about the disease since. Ischaemic colitis is usually a disease process that is seen in the elderly. However, the true incidence of the disease remains unknown since many cases are probably never diagnosed. We now know that the disease can occur both with occlusive and non-occlusive vascular disease, the latter being much more common. Although factors that contribute to non-occlusive disease have been identified, often the exact pathophysiology is unclear and this is an area where further research is needed. Known facts about the pathophysiology and aetiology of the disease will be discussed in this chapter. The key to diagnosis is often a high degree of clinical suspicion. Various diagnostic modalities are described, but colonoscopy remains the main instrument of accurate diagnosis. Fortunately the majority of patients will have self-limiting disease and, accordingly, they usually respond to conservative therapy. When the disease progresses to transmural infarction, surgery is required and the prognosis is guarded. Since many of the patients are elderly with other underlying diseases, it is unlikely that major treatment advances will allow us to significantly alter the prognosis in this group of patients with transmural ischaemia.

In this article, we describe a case of colonic ischemia masquerading as colonic carcinoma in a 75-yr-old female. Although this clinical diagnostic problem has been described before, it is rather unusual that the clinical, roentgenographical, endoscopic, and even histopathologic evaluation could not exclude carcinoma with certainty.

We present two cases of rare abdominal pathologies, for which the initial diagnosis appeared simple but turned out to be exceptional pathologies. The first was compatible with simple lithiasic cholecystitis with choledocian obstacle, but was diagnosed as an idiopathic multifocal retroperitoneal fibrosis, also known as Ormond's disease. The second patient presented as an acute appendicitis. After a surgical exploration of the lower right quadrant, which did not allow a diagnosis, a median laparotomy was performed, leading to the diagnosis of ileo-caecal ischemic necrosis caused by lymphocytic phlebitis.

A 67-year-old man, in whom a linear ulcer running from the duodenal bulb to the descending part had been noted 3 years previously, was admitted to our hospital because of abdominal pain and melena. Duodenoscopy revealed a bleeding giant longitudinal ulcer, which was more extensive than before. Tests for Helicobacter pylori (Hp) were negative. The ulcer was cured by endoscopic hemostasis and repeated blood transfusions. Attention must be paid to Hp-negative post-bulbar duodenal ulcers because of the frequent complications including hemorrhage.

Objective: To describe reactive or reparative but atypical epithelial changes that occur in ischemic colitis., Design: Surgical pathology files were searched for the diagnosis "ischemia, bowel." All cases were studied for reactive or reparative atypical changes. These were characterized and correlated with clinical information., Results: Reactive atypical (pseudodysplastic) changes were found in 8 of 28 cases of ischemic bowel. The clinical history did not indicate ischemic colitis in 6 of 8 cases. In 3 cases, neutrophils in the lamina propria or acute cryptitis and crypt abscesses that suggested inflammatory bowel disease were noted., Conclusion: Ischemic changes in the bowel may produce reactive epithelial changes with sufficient atypia to simulate dysplasia. These may be associated with histologic changes that simulate inflammatory bowel disease, specifically ulcerative colitis. Since in most cases even the clinician is not sure whether the patient has ischemia or inflammatory bowel disease and because histologic changes of the latter may occur in ischemic bowel, there is a danger that the atypical reactive ischemic changes could be interpreted as true dysplasia that occurs in inflammatory bowel disease.

Mesenteric ischemia is a life threatening event instead of colic ischemia which recovers in 90% of cases. Three points will be investigated: chronic mesenteric ischemia; acute mesenteric ischemia; colic ischemia.

The main cause of chronic gastrointestinal ischaemia is atherosclerosis. Stenotic lesions of the mesenteric circulation are relatively common, but lead to chronic ischaemic complaints due to collateral circulation in probably only 2-3 per 100,000 inhabitants per year. The classical presentation (post-prandial abdominal pain, weight loss, upper abdominal souffle) is present in a minority of patients only. Symptoms also occur after exercise. Gastric ulcers and diarrhoea are less frequent. Although patients with 2 and 3 vessel involvement (coeliac artery, superior mesenteric artery and inferior mesenteric artery) usually experience the most severe ischemic complaints, patients with single vessel involvement can also develop symptoms. In the diagnosis of cases with abdominal complaints, factors that aggravate or reduce the complaints anamnestically are the guideline for supplementary diagnostics. The more frequent causes of the symptoms are to be excluded first. Doppler-ultrasonography of the mesenteric vessels can detect most stenotic lesions accurately. To establish the diagnosis visceral angiography is needed. A new method of examination is magnetic resonance angiography (MRA). Another new method is tonometry during exercise: a PCO2 value in the lumen that is higher than that in the blood indicates ischaemia. Non-invasive treatment of chronic gastrointestinal ischaemia is aimed at reduction of the gastrointestinal metabolic workload by smaller meals, at suppression of acid secretion, at inhibition of the secretion of gastric acid and on risk factors for atherosclerosis.

Objectives: to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine., Method: a review of the literature according to evidence-based principles was made by all doctors of our department., Results: seven prospective non-randomised reports on routine colonoscopy after abdominal aortic surgery were found. None of the participants found all the reports, and the last was identified by the reviewer., Conclusions: Endoscopy may disclose ischaemic colitis, but cannot separate transmural from the clinically less important mucosal ischaemia. Endoscopy had no impact on mortality in any of the prospective series. The evidence-based conference was an inspiring teaching modality, and illustrated for the participants the difficulty in performing a targeted literature search., (Copyright 2000 Harcourt Publishers Ltd.)

Important points during differential diagnosis of ulcerative colitis from other inflammatory disorders are endoscopic examination and microbial studies of stools. In acute phase of enterocolitis in which waterly diarrhea with bloody stool and abdominal pain appeared, infectious enterocolitis by Shigella, Salmonella, Campylobacter and Yersinia, which sometimes causes mucosal edema, hyperemia, erosions and ulceration should be distinguished carefully. Microbial studies of stool would bring helpful information in such situation. In chronic phase of inflammatory diseases of bowel, they often showed chronic diarrhea associated with mucobloody stools and abdominal pain. They often revealed mucosal inflammation mimicking ulcerative colitis during endoscopic evaluation. Among them, most important diseases are amebic colitis, ischemic colitis, radiation colitis and antibiotics associated hemorrhagic colitis.