ISCHEMIC COLITIS - 2 DISTINCT PATTERNS OF SEVERITY

Ischaemic colitis accounts for only a small percentage (1 to 2%) of patients with colonic pathology seen in gastrointestinal and surgical wards. Because its presentation is non-specific and as numerous conditions may favour its development, ischaemic colitis is probably frequently misdiagnosed and its incidence underestimated. At presentation, the severity of early stage disease may vary considerably with the prevalent benign 'transient' forms being amenable to conservative regimens and the severe 'gangrenous' forms, requiring surgery.'' The percentage of surgical cases in a given series ranges widely (from 2(6) to 42%).7 These differences have been referred to repeatedly2 4 8 since the key report by Marston et al in 1966 (these authors also specify a third category, ischaemic stricture; however, this will not be dealt with here because, even if it does exist,9 it will only be diagnosed at a later date).1 This review covers diagnosis, predisposing factors, lesion distribution, treatment, and results. It is based on reports (in the literature) and our own six year series of 34 patients of which 13 were treated surgically and 21 conservatively.35