Colorectal SurgeryPending review

Ischaemic Colitis

A fall in colonic perfusion below what the mucosa needs, striking hardest at the watershed zones where two arterial territories barely overlap, so the splenic flexure suffers first and the resulting mucosal injury produces the classic pairing of left-sided pain and bloody diarrhoea.

In a nutshell

Ischaemic colitis is usually a low-flow state, not an occluded artery, striking hardest at watershed zones (splenic flexure, rectosigmoid junction) where collateral supply is sparsest. Mucosal injury there produces crampy left-sided pain with bloody diarrhoea, and management is supportive unless transmural infarction develops.

Classic presentation

An older patient with vascular risk factors or recent hypotension develops sudden crampy left iliac fossa pain followed within hours by bloody diarrhoea.

Key points

The splenic flexure (Griffiths' point) and rectosigmoid junction (Sudek's point) are watershed zones between the SMA and IMA territories, and are hit first whenever perfusion falls.

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Educational content pending clinical review. Not medical advice.