Ischemic colitis: Difference between revisions
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==Disposition== | ==Disposition== | ||
* Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO. | |||
* Most patients can be discharged | |||
* Need follow up colonoscopy in months to ensure no underlying etiology. | |||
==See Also== | ==See Also== | ||
Revision as of 03:40, 18 September 2025
Background
Intestinal Ischemic Disorder Types
- Ischemic colitis
- Accounts for 80-85% of intestinal ischemia
- Due to non-occlusive disease with decreased blood flow to the colon.
- Causes decreased perfusion leading to sub-mucosal or mucosal ischemia only.
- Typical to the "watershed areas" of the colon (Splenic flexure or Sigmoid)
- Acute mesenteric ischemia
- Due to complete occlusion of mesenteric vessels
- Complete transmural ischemia
- Mesenteric venous thrombosis
- Chronic mesenteric ischemia ("intestinal angina")
Clinical Features
- Consider ischemic colitis as the possible cause of acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities.[1]
- Frequently presents with bloody diarrhea and abdominal pain
Differential Diagnosis
Colitis
- Infectious colitis
- Ischemic colitis
- Ulcerative colitis
- CMV colitis
- Crohn's colitis
- Toxic colitis (antineoplastic agents)
- Pseudomembranous colitis
- Fibrosing colonopathy (Cystic fibrosis)
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
Workup
- CBC to evaluate for quantity of blood loss
- CMP to evaluate for acute renal injury
- CT Abdomen and Pelvis with Contrast to evaluate for intestinal inflammation. May consider CTA to rule out mesenteric ischemia.
Diagnosis
- CT will show colitis. Ischemic colitis most likely when found in splenic flexure or sigmoid colon. Ischemic colitis unlikely for colitis that localizes to other areas
Management
- Antibiotics, if the patient has any of the factors associated with severe disease.[2]
- Emergent surgical consultation for:[3]
- Peritoneal signs
- Pneumatosis coli
- Portal venous gas
- Pan-colonic distribution, or
- Isolated right-colon ischemia on imaging
Disposition
- Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO.
- Most patients can be discharged
- Need follow up colonoscopy in months to ensure no underlying etiology.