Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
Other diagnostic factors
- hematochezia/melena
- diarrhea
- abdominal tenderness
- weight loss
- abdominal bruit
- vasculitis
- light headedness, pallor, dyspnea
- food fear (sitophobia)
Risk factors
- old age
- history of smoking
- hypercoagulable states
- atrial fibrillation
- myocardial infarction
- structural heart defects
- history of vasculitis
- atherosclerosis
- recent cardiovascular surgery
- shock
- congestive heart failure
- previous ileostomy
- irritable bowel syndrome
- colonic carcinoma
- constipation
- long-term laxative use
- use of vasopressors, digitalis, cocaine
Diagnostic investigations
1st investigations to order
- CT angiogram
- CBC
- chemistry panel including serum lactate
- coagulation panel
- arterial blood gas/lactate level
- ECG
- erect CXR
- abdominal x-rays
- sigmoidoscopy or colonoscopy
Investigations to consider
- magnetic resonance imaging/magnetic resonance angiography
- mesenteric angiography
- mesenteric duplex ultrasound
Treatment algorithm
evidence of infarction, perforation, or peritonitis
no evidence of infarction, perforation, or peritonitis
chronic mesenteric ischemia
nonacute colonic ischemia
Contributors
Authors
Monjur Ahmed, AGAF, FACG, FACP, FASGE, FRCP, MD, MRCP
Clinical Associate Professor
Thomas Jefferson University
Gastroenterologist
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
MA declares that he has no competing interests.
Acknowledgements
Dr Monjur Ahmed would like to gratefully acknowledge Dr Alex von Roon, Dr James Lewis, Dr Amir Bastawrous, Dr Jennifer Holder-Murray, and Dr Alessandro Fichera, previous contributors to this topic.
Disclosures
AVR, JL, AB, JHM, and AF declare that they have no competing interests.
Peer reviewers
Eli D. Ehrenpreis, MD
Professor of Medicine
Rosalind Franklin University Medical School
Chicago
IL
Disclosures
EDE declares that he has no competing interests.
Andrew Poullis, BSc, MBBS, MD, FRCP
Consultant Gastroenterologist
St George’s Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Differentials
- Infectious colitis
- Ulcerative colitis
- Crohn disease
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