Ischemic colitis - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:14:33Z

Prepared the page for translation

← Older revision		Revision as of 23:14, 4 January 2026
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	==Background==		==Background==

	[[File:Diameters of the large intestine.png\|thumb\|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]		[[File:Diameters of the large intestine.png\|thumb\|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
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	{{Intestinal ischemia types}}		{{Intestinal ischemia types}}
			<translate>


	===Risk Factors===		===Risk Factors===
	*[[Constipation]] (increased intraluminal pressure compresses vessels)
	*[[IBS]]		*[[Special:MyLanguage/Constipation\|Constipation]] (increased intraluminal pressure compresses vessels)
			*[[Special:MyLanguage/IBS\|IBS]]
	*Vascular risk factors		*Vascular risk factors
	*[[COPD]] (risk doubles)<ref>Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.</ref>		*[[Special:MyLanguage/COPD\|COPD]] (risk doubles)<ref>Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.</ref>
	*Females > Males		*Females > Males


	==Clinical Features==		==Clinical Features==

	''*Consider in all patients patients ≥50 years old with acute-onset abdominal pain and cardiovascular morbidities.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>''		''*Consider in all patients patients ≥50 years old with acute-onset abdominal pain and cardiovascular morbidities.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>''
	* Typically presents with:		* Typically presents with:
	**[[Bloody diarrhea]]		**[[Special:MyLanguage/Bloody diarrhea\|Bloody diarrhea]]
	**Diffuse [[abdominal pain]]		**Diffuse [[Special:MyLanguage/abdominal pain\|abdominal pain]]


	===Precipitants===		===Precipitants===

	''Can be precipitated by any illness that decreases flow to the colon.''		''Can be precipitated by any illness that decreases flow to the colon.''
	*[[Hypovolemia]]		*[[Special:MyLanguage/Hypovolemia\|Hypovolemia]]
	*[[Blood loss]]		*[[Special:MyLanguage/Blood loss\|Blood loss]]
	*[[Dialysis]]		*[[Special:MyLanguage/Dialysis\|Dialysis]]
	*[[Anaphylaxis]]		*[[Special:MyLanguage/Anaphylaxis\|Anaphylaxis]]
	*[[Pancreatitis]]		*[[Special:MyLanguage/Pancreatitis\|Pancreatitis]]
	*[[Drugs]]:		*[[Special:MyLanguage/Drugs\|Drugs]]:
	* [[NSAIDs]]		* [[Special:MyLanguage/NSAIDs\|NSAIDs]]
	** [[Cocaine]]		** [[Special:MyLanguage/Cocaine\|Cocaine]]
	** [[Anti-hypertensives]]		** [[Special:MyLanguage/Anti-hypertensives\|Anti-hypertensives]]
	** [[Diuretics]]		** [[Special:MyLanguage/Diuretics\|Diuretics]]
	** [[Digitalis]]		** [[Special:MyLanguage/Digitalis\|Digitalis]]
	** Carboplatin-paclitaxel		** Carboplatin-paclitaxel
	** [[Vasopressors]]		** [[Special:MyLanguage/Vasopressors\|Vasopressors]]
	** [[Pseudoephedrine]]		** [[Special:MyLanguage/Pseudoephedrine\|Pseudoephedrine]]
	** Triptans		** Triptans
	** Interferon-[[Ribavirin]]		** Interferon-[[Special:MyLanguage/Ribavirin\|Ribavirin]]


	==Differential Diagnosis==		==Differential Diagnosis==

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	{{Colitis types}}		{{Colitis types}}
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	{{Abdominal Pain DDX Diffuse}}		{{Abdominal Pain DDX Diffuse}}
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	==Evaluation==		==Evaluation==

	[[File:Ischaemische Colitis 67W - CT - 001.jpg\|thumb\|Ischemic colitis primarily in the transverse colon, confirmed endoscopically.]]		[[File:Ischaemische Colitis 67W - CT - 001.jpg\|thumb\|Ischemic colitis primarily in the transverse colon, confirmed endoscopically.]]
	[[File:Ischemic colitis t-colon.jpg\|thumb\|Ischemic colitis of the transverse colon on endoscopy.]]		[[File:Ischemic colitis t-colon.jpg\|thumb\|Ischemic colitis of the transverse colon on endoscopy.]]

	===Workup===		===Workup===

	* CBC to evaluate for quantity of blood loss		* CBC to evaluate for quantity of blood loss
	* CMP to evaluate for acute renal injury		* CMP to evaluate for acute renal injury
	* CT Abdomen and Pelvis with Contrast to evaluate for intestinal inflammation.		* CT Abdomen and Pelvis with Contrast to evaluate for intestinal inflammation.
	* May consider CTA to rule out mesenteric ischemia, but will rarely show large vessel occlusion.		* May consider CTA to rule out mesenteric ischemia, but will rarely show large vessel occlusion.


	===Diagnosis===		===Diagnosis===

	*Diagnosis is typically determined on abdominopelvic CT		*Diagnosis is typically determined on abdominopelvic CT
	** Ischemic colitis most likely when found in splenic flexure or sigmoid colon. Ischemic colitis unlikely for colitis that localizes to other areas		** Ischemic colitis most likely when found in splenic flexure or sigmoid colon. Ischemic colitis unlikely for colitis that localizes to other areas


	==Management==		==Management==
	*[[Antibiotics]], if the patient has any of the factors associated with severe disease.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
			*[[Special:MyLanguage/Antibiotics\|Antibiotics]], if the patient has any of the factors associated with severe disease.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
	*Emergent surgical consultation for:<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>		*Emergent surgical consultation for:<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
	**Peritoneal signs		**Peritoneal signs
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	**Isolated right-colon ischemia on imaging		**Isolated right-colon ischemia on imaging
	* Improved hydration		* Improved hydration
	* Avoid [[NSAIDs]]		* Avoid [[Special:MyLanguage/NSAIDs\|NSAIDs]]
	* Bowel rest with clear liquid diet		* Bowel rest with clear liquid diet


	==Disposition==		==Disposition==

	* Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO.<ref>Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.</ref>		* Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO.<ref>Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.</ref>
	* Most patients can be discharged		* Most patients can be discharged
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	* Ensure future workup for younger patients		* Ensure future workup for younger patients
	**More likely to have underlying vasculitis or other cause.		**More likely to have underlying vasculitis or other cause.


	==See Also==		==See Also==
	*[[Colitis]]
	*[[Mesenteric ischemia]]		*[[Special:MyLanguage/Colitis\|Colitis]]
			*[[Special:MyLanguage/Mesenteric ischemia\|Mesenteric ischemia]]


	==External Links==		==External Links==

	*[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]		*[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
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Rossdonaldson1: /* Background */

2025-09-24T21:00:47Z

Background

← Older revision		Revision as of 21:00, 24 September 2025
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	==Background==		==Background==
			[[File:Diameters of the large intestine.png\|thumb\|Average inner diameters and ranges of different sections of the large intestine.<ref> Nguyen H, Loustaunau C, Facista A, Ramsey L, Hassounah N, Taylor H, et al. (July 2010). "Deficient Pms2, ERCC1, Ku86, CcOI in field defects during progression to colon cancer". Journal of Visualized Experiments (41). doi:10.3791/1931. PMC 3149991. PMID 20689513.</ref>]]
	{{Intestinal ischemia types}}		{{Intestinal ischemia types}}

Rossdonaldson1: /* Evaluation */

2025-09-24T20:58:58Z

Evaluation

← Older revision		Revision as of 20:58, 24 September 2025
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	==Evaluation==		==Evaluation==
	[[File:Ischaemische Colitis 67W - CT - 001.jpg\|thumb\|Ischemic colitis primarily in the transverse colon, confirmed endoscopically.]]		[[File:Ischaemische Colitis 67W - CT - 001.jpg\|thumb\|Ischemic colitis primarily in the transverse colon, confirmed endoscopically.]]
			[[File:Ischemic colitis t-colon.jpg\|thumb\|Ischemic colitis of the transverse colon on endoscopy.]]
	===Workup===		===Workup===
	* CBC to evaluate for quantity of blood loss		* CBC to evaluate for quantity of blood loss

Rossdonaldson1: /* Evaluation */

2025-09-24T20:57:23Z

Evaluation

← Older revision		Revision as of 20:57, 24 September 2025
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	==Evaluation==		==Evaluation==
			[[File:Ischaemische Colitis 67W - CT - 001.jpg\|thumb\|Ischemic colitis primarily in the transverse colon, confirmed endoscopically.]]
	===Workup===		===Workup===
	* CBC to evaluate for quantity of blood loss		* CBC to evaluate for quantity of blood loss

Rossdonaldson1: /* References */

2025-09-24T18:26:32Z

References

← Older revision		Revision as of 18:26, 24 September 2025
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	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
	~~Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.~~

Rossdonaldson1: /* Diagnosis */

2025-09-24T18:23:43Z

Diagnosis

← Older revision		Revision as of 18:23, 24 September 2025
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	===Diagnosis===		===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		*Diagnosis is typically determined on abdominopelvic CT
			** Ischemic colitis most likely when found in splenic flexure or sigmoid colon. Ischemic colitis unlikely for colitis that localizes to other areas

	==Management==		==Management==

Rossdonaldson1: /* Management */

2025-09-24T18:22:51Z

Management

← Older revision		Revision as of 18:22, 24 September 2025
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	==Management==		==Management==
	*Antibiotics, if the patient has any of the factors associated with severe disease.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>		*[[Antibiotics]], if the patient has any of the factors associated with severe disease.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
	*Emergent surgical consultation for:<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>		*Emergent surgical consultation for:<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>
	**Peritoneal signs		**Peritoneal signs
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	**Isolated right-colon ischemia on imaging		**Isolated right-colon ischemia on imaging
	* Improved hydration		* Improved hydration
	* Avoid NSAIDs		* Avoid [[NSAIDs]]
	* Bowel rest with clear liquid diet		* Bowel rest with clear liquid diet

Rossdonaldson1: /* Disposition */

2025-09-24T18:22:20Z

Disposition

← Older revision		Revision as of 18:22, 24 September 2025
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	==Disposition==		==Disposition==
	* Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO.		* Admit patient with more severe symptoms. Pain uncontrolled, large volume blood loss, unable to tolerate PO.<ref>Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg. 2012 Dec;25(4):228-35. doi: 10.1055/s-0032-1329534. PMID: 24294125; PMCID: PMC3577613.</ref>
	* Most patients can be discharged		* Most patients can be discharged
	* Need follow up colonoscopy in months to ensure no underlying etiology.		* Need follow up colonoscopy in months to ensure no underlying etiology.

Rossdonaldson1: /* Precipitants */

2025-09-24T18:21:47Z

Precipitants

← Older revision		Revision as of 18:21, 24 September 2025
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	===Precipitants===		===Precipitants===
	''Can be precipitated by any illness that decreases flow''		''Can be precipitated by any illness that decreases flow to the colon.''
	*[[Hypovolemia]]		*[[Hypovolemia]]
	*[[Blood loss]]		*[[Blood loss]]

Rossdonaldson1: /* Clinical Features */

2025-09-24T18:18:14Z

Clinical Features

← Older revision		Revision as of 18:18, 24 September 2025
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	==Clinical Features==		==Clinical Features==
	''*Consider ~~as the possible cause of~~ acute-onset abdominal pain ~~with rectal bleeding in patients age 50~~ and ~~older with~~ cardiovascular morbidities.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>''		''*Consider in all patients patients ≥50 years old with acute-onset abdominal pain and cardiovascular morbidities.<ref>[http://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/ Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net]</ref>''
	* ~~Frequently~~ presents with [[~~bloody~~ diarrhea]] ~~and may have mucous as well and~~ [[abdominal pain]]		* Typically presents with:
			**[[Bloody diarrhea]]
			**Diffuse [[abdominal pain]]

	===Precipitants===		===Precipitants===