- Atherosclerosis: Narrowing of arteries due to plaque buildup reduces blood flow to the colon.
- Blood Clots: The formation of clots in blood vessels supplying the colon can block circulation and cause ischaemia.
- Low Blood Pressure: Prolonged hypotension reduces overall blood flow to the digestive system, affecting the colon.
- Previous Abdominal Surgery: Surgical procedures can affect blood vessel positioning or create adhesions, impacting circulation.
- Age: Individuals over 60 are at higher risk due to the increased prevalence of vascular conditions.
- Medications: Certain drugs, including diuretics and vasoconstrictors, can reduce colonic blood flow by lowering blood pressure or constricting blood vessels.
Colonic Ischaemia

Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Colonic ischaemia occurs when blood flow to the colon becomes reduced or blocked, leading to tissue damage in the large intestine. This condition affects the colon’s ability to function properly and can cause inflammation, ulceration, and in severe cases, tissue death. The extent of damage depends on the duration and severity of blood flow reduction.




Symptoms of Colonic Ischaemia
Colonic ischaemia presents with a variety of symptoms that can appear suddenly or develop gradually, depending on the severity of the condition.
- Abdominal Pain: Cramping pain, often sudden in onset, is typically localised to the left side of the abdomen. The pain may intensify after eating.
- Changes in Bowel Habits: Patients may experience urgent bowel movements or diarrhoea, which can occasionally contain blood or mucus.
- Nausea and Vomiting: These symptoms often accompany abdominal pain and can persist for several hours, worsening discomfort.
- Bloating: Abdominal distension and a feeling of fullness that worsens after meals are common.
- Tenderness: The abdomen, particularly over the affected colon, becomes sensitive to touch, which may indicate underlying inflammation or tissue damage.
Causes and Risk Factors
Colonic ischaemia occurs when blood flow to the colon is reduced, impairing its normal function. Several conditions and risk factors contribute to this reduction:
Types of Colonic Ischaemia
Colonic ischaemia presents in different forms based on the extent of blood flow reduction and tissue damage.
Gangrenous Colitis
This severe form involves complete blockage of blood flow leading to tissue death. The affected portion of the colon may perforate, resulting in a life-threatening condition. Gangrenous colitis requires urgent surgical intervention and carries a high risk of mortality without prompt treatment.
Non-Gangrenous Colitis
This milder form involves a partial reduction in blood flow. The colon wall becomes inflamed but remains viable. Most cases resolve with conservative treatment, including hydration, symptom management, and close monitoring.
Chronic Colonic Ischaemia
This rare form develops gradually over time due to progressive narrowing of blood vessels. Patients experience recurring symptoms that typically worsen after meals and may lead to weight loss and malnutrition.
Diagnostic Methods
Physical Examination
The doctor checks for abdominal tenderness, bowel sounds, and signs of peritonitis. Vital signs are closely monitored to assess blood circulation and detect potential shock. A rectal examination may also be performed to check for blood in the stool.
Laboratory Tests
Blood tests check for infection markers, anaemia, and organ function. Stool samples are analysed for blood and potential infectious agents. Coagulation studies are performed to detect clotting disorders that may contribute to ischaemia.
Imaging Studies
CT scans with contrast help visualise blood flow to the colon and identify areas of inflammation or perforation. Abdominal X-rays can show bowel wall thickening or free air if perforation has occurred.
Colonoscopy
Direct visualisation of the colon mucosa reveals areas of inflammation, ulceration, or necrosis. This procedure requires careful consideration due to the risk of perforation in severe cases.
Treatment Options
The approach to treating colonic ischaemia depends on the severity of symptoms and the extent of tissue damage, ranging from conservative care to surgical intervention.
Non-Surgical Treatment
- Bowel Rest: Patients stop oral intake temporarily to reduce colonic workload. Intravenous fluids maintain hydration and electrolyte balance. Gradual reintroduction of food occurs as symptoms improve.
- Antibiotic Therapy: Broad-spectrum antibiotics prevent bacterial translocation through damaged bowel walls. Treatment continues until clinical improvement occurs and infection markers normalise.
- Anticoagulation: Blood thinners are prescribed to address underlying clotting disorders, helping to restore and maintain proper blood flow. Dosing is carefully adjusted based on regular monitoring of coagulation parameters to ensure safety and effectiveness.
Surgical Treatment
- Bowel Resection: This procedure involves removing necrotic (dead) segments of the colon in cases of gangrenous ischaemia. Depending on the extent of tissue removal, the surgery may require the creation of a temporary or permanent stoma to allow waste elimination while the bowel heals or adapts.
- Vascular Intervention: Restoring blood flow to the colon is necessary when vascular blockages are the underlying cause. This may involve bypass surgery to reroute blood flow around a blocked artery or endovascular techniques such as clot removal (thrombectomy) or stent placement to reopen narrowed blood vessels and improve circulation.
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Prevention and Management
Regular exercise, maintaining healthy blood pressure, and managing underlying conditions like diabetes and heart disease help reduce risk. Smoking cessation and limiting alcohol intake improve vascular health. Patients with previous episodes require regular medical follow-up and may need long-term anticoagulation. Dietary modifications, including smaller, more frequent meals, can help prevent symptom recurrence.
Frequently Asked Questions
Can colonic ischaemia recur after successful treatment?
Yes, recurrence is possible, especially if underlying risk factors, such as vascular disease or clotting disorders, are not adequately managed. Ongoing follow-up care is required, including regular monitoring of vascular health, lifestyle modifications, and addressing medical conditions that may contribute to future episodes.
How long does recovery take after non-surgical treatment?
For non-gangrenous colitis, most patients experience improvement within 1–2 weeks of conservative treatment, such as hydration and symptom management. Complete healing of the colonic mucosa typically occurs within 4–6 weeks, depending on the severity of the condition and adherence to medical recommendations.
Can I continue my medications if I’ve had colonic ischaemia?
Some medications, like diuretics or vasoconstrictors, may increase the risk of ischaemia. Your doctor will review your medications and make necessary adjustments to ensure they are safe for you to continue.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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