Necrotizing Colitis

By MMI board-certified, academically affiliated clinician 
May 10, 2018

Necrotizing colitis (NC) is a serious health problem. It happens when part of your colon dies. This is often because of colon cancer. If you have NC, it usually means you need to have emergency surgery.

Your large intestine is part of your digestive (gastrointestinal or GI) tract. The GI tract goes from your mouth down to your rectal opening. The large intestine is made up of your colon and rectum. The colon receives food that’s broken down in your small intestine. One of the colon’s main jobs is to reabsorb water and electrolytes, such as salt. The colon leads to your rectum. This is where your stool is stored before bowel movements.

In NC, part of the tissue in your colon dies. Only a part of the wall of the colon might die. Or the whole thickness of the wall might die. This happens when the cells on the wall of your colon don’t get enough blood and oxygen.

NC is a very uncommon condition. It only happens if a health problem with the colon leads to trouble with blood flow. This happens most often with colon cancer. Colon cancer is most likely to happen in older adults. The cancer can block and reduce blood flow. This can cause cell death.

Colon cancer is the main cause of NC. But NC isn’t a common complication from colon cancer. Other health problems that can cause NC include:

  • Strangulated hernia
  • Hirschsprung disease
  • Diverticulitis
  • Volvulus
  • Fecal impaction
  • Malfunctioning colostomy

All of these issues can block your colon. This can decrease blood flow to your colon. If the blood flow slows down or stops, part of your colon dies. This is because it doesn’t get enough oxygen. The low oxygen levels also cause bacteria to grow. These bacteria may make toxins than can destroy nearby tissue.  

Having certain health issues may raise your risk of NC. These may include:

  • Diabetes
  • Atherosclerosis
  • Ischemic heart disease

You may also have a higher risk of NC if you have factors that increase your risk of colon cancer. Some of these factors include the following:

  • Colorectal polyps
  • Inflammatory bowel disease
  • Family history of colon cancer
  • Smoking
  • Drinking a lot of alcohol
  • Obesity
  • Not exercising enough

People with NC have stomach pain and tenderness. This may be severe. This often comes on fairly suddenly. Other symptoms might include:

  • Bleeding from your rectum
  • Nausea or vomiting
  • Stomach swelling (distension)
  • Constipation or diarrhea
  • Fever
  • Symptoms of shock and sepsis. These may include low blood pressure, fainting, not making as much urine as normal, and confusion.

Your healthcare provider will ask about your health history. He or she will also ask you about your symptoms and health conditions. He or she will look for health issues that can lead to NC, such as colon cancer. Your healthcare provider will also give you a full exam, focusing on your abdomen.

You will have more tests before your healthcare provider can tell if you have NC. These tests may include:

  • Blood tests, to check your red blood cell count. These tests can also look for infection and inflammation.
  • Tests to measure the amount of oxygen in your blood
  • Abdominal ultrasound, X-ray, or CT scan, to show details of your GI tract.
  • Colonoscopy. In this test, a long tube with a tiny camera looks at your colon from the inside.

A CT and colonoscopy may show a blockage in your colon. But NC often cannot be diagnosed until you have surgery. 

You will likely need emergency surgery to treat NC. Your surgeon will take out the damaged part of your colon. He or she will then surgically join the parts that are left.

Before and after the surgery, you may need supportive care. This means that you may need to stay in the intensive care unit of the hospital. Your treatment may include:

  • Breathing support with a breathing machine (ventilator)
  • IV (intravenous) fluids. This will treat shock.
  • Blood transfusion. This is to replace blood loss during surgery.
  • Medicines to treat and prevent infections.

Your care plan will depend on your condition before and after surgery. You may also need treatment for the cause of your NC, such as colon cancer.

Many people fully recover after NC. Others may have long-term complications. This condition can even cause death. This is more likely if you don’t seek treatment right away.

NC can lead to sepsis and shock. This can harm your organs. This might cause temporary or permanent damage, such as kidney failure. It can even cause severe shock. This may lead to death. Your healthcare team will work hard to prevent this.

Complications sometimes happen from surgery. For instance, you may have heavy bleeding or infection in another part of your body.

You may be able to reduce your chance of getting NC by following a healthy lifestyle. A healthy lifestyle includes:

  • Eating a nutritious diet
  • Keeping a healthy weight through diet and regular exercise
  • Avoiding smoking
  • Limiting alcohol

Have colonoscopies for cancer screening as often as your healthcare provider suggests.

See your healthcare provider right away if you have signs of NC. These include severe stomach pain.

  • NC is a serious health problem. It happens when part of your colon dies. This is often because of colon cancer.
  • NC happens when there is a blockage in your colon. This reduces blood flow to the tissue. This causes part of your colon to die.
  • Intense stomach pain is often a symptom of NC.
  • NC usually requires emergency surgery. Your surgeon will take out the damaged part of your colon. NC often cannot be diagnosed until you have surgery.
  • Many people fully recover after NC. Others may have long-term complications. This condition can sometimes cause death.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


May 10, 2018


Gaieski D. Shock in adults: types, presentation, and diagnostic approach. UpToDate. http://www.uptodate.com/contents/shock-in-adults-types-presentation-and-diagnostic-approach, Pauley-Hunter, R. Pathophysiology of Short Bowel Syndrome. UpToDate. http://www.uptodate.com/contents/pathophysiology-of-the-short-bowel-syndrome, Brandt, L. ACG Clinical Guideline: Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI). http://gi.org/wp-content/uploads/2015/01/ACG_Guideline_Colon-Ischemia_January_2015.pdf, Matsunaga H, Shida D, Kamesaki M, Hamabe Y. Acute necrotizing colitis due to sigmoid colon cancer. World J Surg Oncol. 2014;27(12):19., Moldovan R, Vlad N, Curca G, et al. Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review. Chirurgia. 2013;108(3):396-399.

Reviewed By:  

Lehrer, Jenifer, MD,Sather, Rita, RN