Gastroenterological Medicine:Ischemic Enteritis

• Circulate disorder is leading to necrosis or ulceration on mucosal.
• Endoscope exam is necessary but there may be the case of insertion difficulty
• Surgical operation is necessary for gangrenous and arctation type.

Circulatory disorder is leading to necrosis or ulceration on mucosal.

The disease is that reversible circulatory disorder of large intestine is leading to regional denaturalization, necrosis or ulceration on mucosal. It is suspected that the increase of gut tract internal pressure by constipation, or circulation disorder accompanied with arterial sclerosis are related. This is one of few diseases which can be diagnosed by the symptom. Its main complained is that most of the case disease can be diagnosed by blood feces.

Endoscope exam is necessary but there is a case where insertion is difficult.

Abdominal Echo is effective for early stage diagnosis. Many cases of wall thickening of sigmoid colon can be mostly found by abdominal echo exam. At lower alimentary tract endoscope exam, it recognizes the longitudinal ulcer or erosion along the bands of colon (typically with corresponding to bands of colon, there are three strip-shaped ulcer), on early stage, and edema on healthy mucosal between reddening or edema around the main pathological abnormality can be seen. Pathological abnormality is just a regional and boundary to healthy portion is clearly defined. For those of ischemic enteritis person, as they have difficulty in action of the bowels coming from clinical condition, in case sigmoid colon is a bit longer, and crooked many, it is likely difficult to insert the tube in the lower alimentary tract endoscope exam. They are mostly the case where it is an autogenous healing, or they are just a longer colon, but there sometimes exist a bigger polyp or bowel cancer is hidden, so that it is necessary to take lower alimentary tract endoscope exam once.

Surgical operation is necessary for gangrenous and arctation type.

Due to the dissemination of lower alimentary tract endoscope, many cases are diagnosed as mild case. They are grouped from disease trajectory into transient, arctation and gangrenous types. The majority is a transient type, and gangrenous type is rare case.

Transient Type

Transient type will be improved to the level of reddening and ulcer scar left in one to two weeks. But in gangrenous type, ulcer healing is protracted in most cases, also accompanied with arctation. The most cases of gangrenous type, edema is still found on abdominal echo test even one month later. When transit disorder is appeared clinically, surgery operation is considered.

Gangrenous Type

Gangrenous type is a rare case, but peritoneal irritation sign is recognized since its early stage. In most cases, the basic of disease resides in high aged and disorder with arterial sclerosis, and the disease are common among patients who has abdominal operation history.

Transient type will be cured by symptomatic therapy, but for gangrenous type and arctation type associated with bowel atresia symptom, surgery operation is applied. To prevent the recurrence, it is important to work out to improve the bowel movement habit.