Ischemic bowel disease

Last reviewed: 4 Nov 2022
Last updated: 08 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
More key diagnostic factors

Other diagnostic factors

  • hematochezia/melena
  • diarrhea
  • abdominal tenderness
  • weight loss
  • abdominal bruit
  • vasculitis
  • light headedness, pallor, dyspnea
  • food fear (sitophobia)
Other diagnostic factors

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
More risk factors

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
More 1st investigations to order

Investigations to consider

  • magnetic resonance imaging/magnetic resonance angiography
  • mesenteric angiography
  • mesenteric duplex ultrasound
More investigations to consider

Treatment algorithm

ACUTE

evidence of infarction, perforation, or peritonitis

no evidence of infarction, perforation, or peritonitis

ONGOING

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.

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