Difference Between Ischemic Colitis and Mesenteric Ischemia

The key difference between ischemic colitis and mesenteric ischemia is that, in ischemic colitis, it is the colon that becomes ischemic, but in mesenteric ischemia, the small bowel wall becomes ischemic.

The lack of blood supply to tissues gives rise to ischemia. Therefore, it is obvious that both ischemic colitis and mesenteric ischemia are conditions due to the inadequate blood supply.

1. Overview and Key Difference
2. What is Ischemic Colitis
3. What is Mesenteric Ischemia
4. Side by Side Comparison – Ischemic Colitis vs Mesenteric Ischemia in Tabular Form
5. Summary

What is Ischemic Colitis?

Superior mesenteric artery and inferior mesenteric artery are the two main arteries responsible for the blood supply of colon. An occlusion in one or both of these arteries results in ischemia of the colonic tissues. The manifestation of this is a sudden onset of severe abdominal pain with profuse per rectal bleeding. The area of splenic flexure is the most vulnerable region to get affected by this condition because of its location. The location is a watershed area due to the manner in which the colonic blood supply develop.

Figure 01: High magnification micrograph of ischemic colitis.

The abdomen is usually tender, and an abdominal x-ray will show the characteristic thumb printing appearance in the splenic flexure.

What is Mesenteric Ischemia?

Mesenteric ischemia is due to the inadequate blood supply to the small bowel wall. Some of the manifestations of this condition are abdominal pain that develops around two hours after eating, weight loss, bloody stool at times, changes in bowel habits, nausea and vomiting. Doppler USS, CT scan of the abdomen occasionally with CT angiography, and Mesenteric angiogram help to confirm the clinical suspicion.

What is the Difference Between Ischemic Colitis and Mesenteric Ischemia?

Ischemic Colitis and Mesenteric Ischemia
Inadequate blood supply to the colon gives rise to ischemic colitis.	Mesenteric ischemia is due to the inadequate blood supply to the small bowel wall.
Ischemia
Colon becomes ischemic.	Small bowel wall becomes ischemia.
Causes
Drugs such as oral contraceptive pills and nicorandil Thrombophilia Small and medium vasculitis	Atherosclerosis Thromboembolism Trauma Different forms of small and medium vessel vasculitis Hypovolemic conditions such as cardiac arrest, septic shock, etc. Use of drugs such as vasopressors and ergotamines
Clinical Features
Sudden onset of severe abdominal pain with profuse per rectal bleeding. Abdomen is usually tender	Abdominal pain which develops about 2 hours after eating Weight loss Sometimes bloody stool Changes in bowel habits Nausea Vomiting
Management
Symptomatic treatment is the mainstay in the management of a patient with this condition. In the patients who continue to deteriorate require immediate surgical intervention to correct the blood supply the ischemic tissues.	Lifestyle modifications are helpful in the improvement of the symptoms when the ischemia is due to atherosclerosis or thromboembolism. Pharmacological intervention is required in more advanced cases to prevent the occlusion of mesenteric vessels. Anticoagulants are the drugs of choice prescribed in such a scenario. Angioplasty with or without stenting, mesenteric artery bypass, and mesenteric endarterectomy are the surgical options available in the treatment.

Summary – Ischemic Colitis vs Mesenteric Ischemia

The major difference between ischemic colitis and mesenteric ischemia is that in ischemic colitis, the blood supply to the colon is reduced whereas, in mesenteric ischemia, the blood supply to the small bowel walls is reduced. Therefore, both are conditions due to the compromised blood supply.

Reference:

1. Kumar, Parveen J., and Michael L. Clark. Kumar & Clark clinical medicine. Edinburgh: W.B. Saunders, 2009.

Image Courtesy:

1. “Ischemic colitis – high mag” By Nephron – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “2821941” (CC0) via Pixabay

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