Summary
Definition
Ischaemic bowel disease encompasses a heterogeneous group of disorders caused by acute or chronic processes, arising from occlusive or non-occlusive aetiologies, which result in decreased blood flow to the gastrointestinal tract. The clinical course may range from transient and reversible to fulminant.
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Histopathology of intestinal ischaemia
From the collection of Dr Jennifer Holder-Murray; used with permission
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History and exam
Other diagnostic factors
- haematochezia/melaena
- diarrhoea
- abdominal tenderness
- weight loss
- abdominal bruit
- vasculitis
- light headedness, pallor, dyspnoea
- food fear (sitophobia)
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, digitalis, cocaine
Diagnostic investigations
1st investigations to order
- FBC
- chemistry panel including serum lactate
- coagulation panel
- arterial blood gas/lactate level
- ECG
- erect CXR
- abdominal x-rays
- CT scan with contrast/CT angiogram
- sigmoidoscopy or colonoscopy
Investigations to consider
- mesenteric angiography
- mesenteric duplex ultrasound
- magnetic resonance angiography
Treatment algorithm
Contributors
Authors VIEW ALL
Clinical Senior Lecturer
Honorary Consultant Colorectal Surgeon
Department of Surgery and Cancer
Imperial College London
London
UK
Disclosures
AVR declares that he has no competing interests.
Clinical Research Fellow
Department of Surgery and Cancer
Imperial College London
London
UK
Disclosures
JL declares that he has no competing interests.
Dr Alex von Roon and Dr James Lewis would like to gratefully acknowledge Dr Amir Bastawrous, Dr Jennifer Holder-Murray, and Dr Alessandro Fichera, the previous contributors to this topic.
Peer reviewers VIEW ALL
Professor of Medicine
Rosalind Franklin University Medical School
Chicago
IL
Disclosures
EDE declares that he has no competing interests.
Consultant Gastroenterologist
St George’s Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
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