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| Name | ISCHAEMIC COLITIS: TWO CASES |
| Video Uploader | Video From monzahmed |
| Upload Date | This Video Uploaded At 04-11-2018 23:02:35 |
| Video Discription | CASE 1 A 56 year old male had a long history of poorly controlled hypertension and type 2 diabetes mellitus leading to retinopathy and chronic renal failure. He also had a past history of paroxysmal AF and multiple PEs and was treated initially with Warfarin for many years, swapping over to Rivaroxaban about a year ago. 18 years ago he sustained an aortic root dissection causing acute renal failure and required a renal transplant. Since then, he has been treated with anti-rejection drugs in the form of Prednisolone, Tacrolimus and (periodically) Mycophenolate Mofetil. 2 years ago he developed chest pain. A CT scan showed type B aortic dissection requiring urgent treatment with a complex EVAR (Endovascular Aortic Repair). 6 months ago he developed an Endoleak which was treated with embolisation. 9 days ago, he was admitted with an acute myocardial infarction complicated by an in-hospital VF arrest. He was successfully resuscitated with a DC shock. A subsequent coronary angiogram showed occlusion of the first diagonal artery which was treated medically (no PCI). Now: - Fresh PR bleeding + clots/ melaena few days after coronary angiography - Hb 8.8 g/dl, 2 units blood transfused - OGD - normal - CT angio: bleeding from caecum ?angiodysplasia See video for colonoscopy... CASE 2 A 26 year old athletic male presented with a one day history of sudden abdominal pain during football practice followed by fresh rectal bleeding and loose bowels. He was previously a regular cocaine user but now was a "light, occasional” user. In addition, he was a regular cannabis smoker. There was no family history of IBD. Initial investigations: - Hb 14.5, WBC 20, CRP 2, Albumin 36 - Stool culture: -ve - AXR: nil significant - Flex sigmoidoscopy #1 (1 day after presentation): limited views, normal rectum/ sigmoid - CT scan: oedema of distal descending colon - Flexible sigmoidoscopy #2 (5 days after presentation) … see video. Ischaemic colitis is the most common type of intestinal ischaemia. The term "ischaemic colitis" was used by Marston (1966) with three typical patterns of injury described: transient reversible ischaemia, ischaemic ulcers with stricturing, and gangrenous ischaemic colitis. Dominant presenting symptoms were colicky abdominal pain, vomiting, bloody diarrhoea, and haematochezia. Patients often have minimal signs on clinical examination. The circulation to the large intestine and rectum is derived from the superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and internal iliac arteries. An extensive collateral circulation protects the intestines from transient periods of inadequate perfusion. However, the "watershed" areas of the colon, which have limited collateral blood flow, such as the splenic flexure (Griffith’s point), rectosigmoid junction (Sudeck’s critical point) and right colon, are at risk for ischaemia particularly related to hypoperfusion. Colonic ischaemia is usually the result of a sudden, but usually transient, reduction in blood flow, the effects of which are particularly prominent at the “watershed” regions of the colon. Prolonged severe ischemia causes necrosis of the villous layer, which can lead to transmural infarction within 8 to 16 hours. Perfusion to the colon can be compromised by changes in the systemic circulation or by anatomic or functional changes in the local mesenteric vasculature. Risk factors include aorto-iliac instrumentation/surgery, cardiopulmonary bypass, myocardial infarction, haemodialysis, acquired or hereditary thrombophilia, certain drugs (e.g. cocaine, metamphetamine, pseudo-ephedrine, NSAIDs etc) and extreme exercise. Clinically, ischaemic colitis is classified as non-gangrenous or gangrenous. Non-gangrenous ischaemic colitis involves the mucosa and submucosa and accounts for 80-85% of cases and is further sub-classified into (1) transient, reversible ischaemic colitis with a less severe form of injury and (2) chronic, non-reversible ischaemic colitis, which includes chronic colitis and stricture and has a more severe form of injury. Gangrenous ischaemic colitis accounts for the remaining 15-20% of cases and manifests as the most severe form of injury. For most patients, management is supportive and non-interventional, and the prognosis for recurrence and survival are excellent. Some with severe disease require surgical intervention. [r_2kpaionUM] |
| Category | Science & Technology |
| Tags | colonoscopy | flexible sigmoidoscopy | endoscopy | ischaemic colitis | colitis | cocaine | exercise induced colitis | hypo-perfusion | ulceration | CT scan | monz | monzahmed | monz ahmed | monzur ahmed |
