Last reviewed:October 2019
Last updated:February  2019

Summary

Definition

History and exam

Key diagnostic factors

  • history of inflammatory bowel disease
  • history of exposure to infectious agents
  • history of recent antibiotic use
  • history of HIV/AIDS/immunosuppressed state
  • fevers/chills
  • tachycardia
  • mental status changes
  • hypotension
  • abdominal distention

Other diagnostic factors

  • diarrhea
  • abdominal pain
  • abdominal tenderness

Risk factors

  • ulcerative colitis (UC)
  • Crohn colitis
  • pseudomembranous colitis
  • infectious colitis
  • HIV/AIDS/immunosuppression
  • discontinuation of medications for inflammatory bowel disease
  • antimotility agents
  • chemotherapy/chemical immunosuppression
  • electrolyte abnormalities

Diagnostic investigations

1st investigations to order

  • CBC
  • serum electrolytes
  • serum albumin levels
  • serum lactic acid
  • stool studies
  • CT abdomen/pelvis
  • abdominal x-ray
  • chest x-ray
Full details

Investigations to consider

  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • blood cultures
  • sigmoidoscopy
  • rectal biopsy
  • surgical specimen
Full details

Treatment algorithm

Contributors

Chief

Colorectal Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JR is the President of the American Board of Colon and Rectal Surgery.

Assistant Professor of Surgery

Department of Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

VPP declares that he has no competing interests.

Dr Jan Rakinic and Dr V. Prasad Poola would like to gratefully acknowledge Dr Scott A. Strong, Dr Mukta V. Krane, and Dr Alessandro Fichera, previous contributors to this topic.

Peer reviewersVIEW ALL

Assistant Professor of Surgery

Division of Colon and Rectal Surgery

University Hospital Case Medical Center

Cleveland

OH

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Consultant

Colorectal Surgeon

Addenbrookes Hospital

Cambridge

UK

Disclosures

JW declares that he has no competing interests.

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