A Review on Colonic Ischemia due to Vasoconstrictors

Author(s): Ikechukwu Okereke, Belonwu Valentine Okafor, Syed Burhanuddin Khadri, Dolly Ogwu, Hassaan Barkat, Ofure Harrison, Sangeetha Krishnamoorthy, Osazee Eguagie, Janet Adebukola Omole, Anusha Thalla, Iya

Intestinal ischemia results due to reduced blood flow to the intestine. Hypoperfusion of mesenteric vasculature can be due to occlusive or nonocclusive etiology. Nonocclusive mesenteric ischemia (NOMI) is due to arterial spasm from vasoconstrictors. Colon ischemia has a reported mortality rate ranging from 6 to 25%, depending upon the causal agent and comorbidities. This review's scope was to examine the body of published literature regarding outcomes of iatrogenic NOMI and compare cocaine-related NOMI with other causes of iatrogenic large bowel ischemia. A literature search was conducted on Pubmed and Google scholar, using "Mesenteric Ischemia" and "Vasoconstrictor" as the Mesh terms. Twenty-two articles (19 case reports, 3 case series) were finally included in our review. Among study subjects, Abdominal pain was the presenting complaint in 88.88% of patients, and bloody bowel movements were reported in 81.48% of patients. Diagnostic modalities used included colonoscopy (59.26%), sigmoidoscopy (23.07%), computed tomography (37.04%), plain abdominal films (11.54%), and laparotomy (19.23%). Combining findings from all the diagnostic modalities revealed pan-colonic involvement in 11.54% of patients, proximal colon in 23.08% of patients, 7.68% of patients had involvement of transverse colon and descending/ sigmoid colon were involved in 55.56%. Splenic flexure region involvement was noticed in 30.77% of cases. Most of the patients had more than one region of bowel involved. Findings of severe colon ischemia, including ulcers, hemorrhages, and gangrene, were found in 70.37% of patients on colonoscopy or autopsy. Nineteen patients (70.37%) were managed conservatively with broad-spectrum antibiotics, intravenous fluids, and bowel rest. Two of them died due to septic shock, while the remaining 17 recovered without any further complications. Eight patients (29.63%) required surgical management, and two of them had septic shock, causing death. In t

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