Ischemic Colitis
Differential Diagnosis
- Quiescent colitis in inflammatory bowel disease may be histologically indistinguishable from chronic ischemia
- Clinical correlation is necessary
- Hemosiderin laden macrophages may suggest ischemia
- Colitis due to E coli O157:H7 may be histologically indistinguishable from acute ischemia
- Clinical correlation is necessary
| Pseudomembranous Colitis | Ischemic Colitis |
| Diffuse | Localized, may form a mass |
| No hyanization of lamina propria | Hyalinized lamina propria |
| Occasional atrophic crypts | Atrophic microcrypts common |
| Usually only superficial necrosis | Necrosis frequently transmural |
| C difficile titer elevated | C difficile titer negative |
| Associated with antibiotic therapy | Not associated with antibiotic therapy |
| Incidental Chronic Colitis | Ischemic Colitis (Chronic) |
| Crypt distortion and dropout | Predominantly hyalinization and fibrosis |
| Prominent basal plasmacytosis | Inflammation not prominent |
| Virtually restricted to cecum/right colon | Most common in splenic flexure |
- Acute ischemic colitis bears no resemblance to incidental chronic colitis
