Ischemic colitis

Pearls

• Consider ischemic colitis as the possible cause of acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities.
• For patients with peritoneal signs, radiographs should be considered for evaluation of ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum.
• Consider ordering a CTA as first-line imaging, especially if there is any suggestion of mesenteric ischemia, right sided tenderness without hematochezia, or if you suspect severe disease. If resources do not allow, order a CT with oral and IV contrast. If IRCI is incidentally found on initial CT, then CTA can be deferred to the inpatient setting and obtained prior to discharge.
• Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.
• Place an emergent surgical consultation for any patient with peritoneal signs on physical exam or pneumatosis coli, portal venous gas, pan-colonic distribution, or isolated right-colon ischemia on imaging.

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")

External Links

Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net Permission to reproduce via Creative Commons Attribution 4.0 International License per emDOCS.net

See Also

• Colitis
• Mesenteric ischemia