Ischemic bowel disease

Last reviewed: 19 Apr 2022
Last updated: 19 Mar 2019

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
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • 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
More 1st investigations to order

Investigations to consider

  • mesenteric angiography
  • mesenteric duplex ultrasound
  • magnetic resonance angiography
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

Alex von Roon, MB, ChB, PhD, FRCS

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.

James Lewis, MBBS, BSc, MRCS

Clinical Research Fellow

Department of Surgery and Cancer

Imperial College London

London

UK

Disclosures

JL declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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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