Hematochezia Information (Ischemic Colitis)

Ischemic Colitis

Hematochezia or blood could be caused by harmless conditions like hemorrhoids or serious ailments like cancer. Hematochezia or rectal bleeding refers to the passage of blood in the stools. Most rectal bleeding originates from the anus, colon or rectum.

Hematochezia is the presence of bright red, fresh blood in the feces. Hematochezia usually occurs with bleeding in the lower intestines (colon, rectum). Hematochezia should not be confused with melena , which is the passage of dark, tarry, black feces. Melena represents the passage of old, digested blood that has occurred with bleeding higher up in the intestinal tract.

The color of the blood depends more on the site of origin of the bleeding. The closer the bleeding site to the anus, the brighter is the color of the blood. Thus, bleeding from the anus, rectum, and the sigmoid colon tend to be bright red, whereas bleeding from the transverse colon and the right colon tend to be dark red or maroon colored. In some patients bleeding can be black and “tarry” (sticky) and foul smelling.

Ischemic Colitis

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Ischemic Colitis Treatment (Ischemic Colitis)

Ischemic Colitis

Treatment of the patient is dictated by the severity of the ischemia. In the absence of colonic gangrene or perforation, supportive care is appropriate. Patients should be placed on bowel rest and given intravenous fluids to ensure adequate colonic perfusion. Optimization of cardiac function and oxygenation is important. Empiric broad-spectrum antibiotics are often administered in patients with moderate to severe colitis to minimize bacterial translocation and sepsis.

Although there is a lack of prospective, clinical data on humans, this practice is generally justified because of the difficulty in predicting who will progress to gangrenous colitis. A nasogastric tube should be placed if an ileus is present. A rectal tube may also be helpful if the colon is distended. In critically ill patients with uncertain hemodynamic status, Swan-Ganz catheterization may assist in guiding fluid status and cardiac function. Any medications that are associated with ischemia should be withheld. Careful monitoring is necessary for signs of necrosis, such as persistent fever, leukocytosis, peritoneal irritation, or protracted pain or bleeding. Serial abdominal radiographs may be helpful if colonic distension or thumbprinting are present. Cathartics should be avoided because they may rarely precipitate colonic perforation. Most patients with ischemic colitis will clinically improve within 24 to 48 hours, and endoscopic and radiologic abnormalities resolve within several weeks.

Approximately 20% of patients with ischemic colitis will require surgery because of peritonitis or clinical deterioration despite conservative management. At laparotomy margins. Questionably viable areas of colon are generally resected unless extensive areas of small and large bowel are affected, in which case these areas are left intact and a second-look operation is planned 12 to 24 hours later. Primary anastomosis is usually not performed because of the risk of anastomotic leaks. A colostomy is formed with the proximal colonic loop and the distal loop is either exteriorized as a mucous fistula or closed to form a Hartman pouch. Despite resection, the mortality rates exceed 50% in those with infarcted bowel.

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Ischemic Colitis

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