Ischaemic bowel disease

Last reviewed: 2 Sep 2022
Last updated: 28 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • abdominal tenderness
  • presence of risk factors
Full details

Other diagnostic factors

  • haematochezia/melaena
  • diarrhoea
  • nausea
  • weight loss
  • abdominal bruit
  • vasculitis
  • light headedness, pallor, dyspnoea
  • food fear (sitophobia)
Full details

Risk factors

  • old age
  • history of smoking
  • hypercoagulable states
  • atrial fibrillation
  • myocardial infarction
  • structural heart defects
  • history of vasculitis
  • recent cardiovascular surgery
  • shock
  • congestive heart failure
  • atherosclerosis
  • previous ileostomy
  • irritable bowel syndrome
  • colonic carcinoma
  • constipation
  • long-term laxative use
  • use of vasopressors, digoxin, cocaine
Full details

Diagnostic investigations

1st investigations to order

  • CT scan with contrast/CT angiogram
  • FBC
  • arterial blood gases and serum lactate
  • urea and electrolytes
  • liver function tests
  • amylase
  • coagulation studies, group and save and crossmatch
  • ECG
  • erect CXR
  • abdominal x-rays
  • sigmoidoscopy or colonoscopy
  • upper gastrointestinal endoscopy
  • D-dimer
Full details

Investigations to consider

  • mesenteric angiography
  • mesenteric duplex ultrasound
  • magnetic resonance angiography
  • CRP
  • studies for ova, cysts, and parasites
  • faecal culture
  • Clostridium difficile toxin assay
Full details

Treatment algorithm

ACUTE

evidence of infarction, perforation, or peritonitis on diagnostic computed tomography scan

no evidence of infarction, perforation, or peritonitis on diagnostic computed tomography scan

ONGOING

chronic mesenteric ischaemia

ischaemic colitis

non-acute colonic ischaemia

Contributors

Expert advisers

John Abercrombie, FRCS

General and Colorectal Surgeon

Queen’s Medical Centre

Nottingham

UK

Biography

JA has been Clinical Lead for General Surgery, Getting It Right First Time.

Disclosures

JA is a council member of the Royal College of Surgeons of England.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Alex von Roon, MB, ChB, PhD, FRCS

Clinical Senior Lecturer

Honorary Consultant Colorectal Surgeon

Department of Surgery and Cancer

Imperial College London

London

UK

James Lewis, MBBS, BSc, MRCS

Clinical Research Fellow

Department of Surgery and Cancer

Imperial College London

London

UK

Peer reviewers

Frances Howse, MA (Oxon), BM (Hons), FRCS (Eng)

Consultant

Acute and General Surgery

University Hospital Southampton NHS Foundation Trust

Southampton

UK

Disclosures

FH declares that she has no competing interests.

Editors

Emma Quigley,

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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