Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- abdominal tenderness
- presence of risk factors
Other diagnostic factors
- haematochezia/melaena
- diarrhoea
- nausea
- 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
- irritable bowel syndrome
- colonic carcinoma
- constipation
- long-term laxative use
- use of vasopressors, digoxin, cocaine
Diagnostic investigations
1st investigations to order
- CT scan with contrast/CT angiogram
- FBC
- arterial blood gases and serum lactate
- urea and electrolytes
- liver function tests
- CRP
- coagulation studies, group and save and crossmatch
- ECG
- erect CXR
- sigmoidoscopy or colonoscopy
- upper gastrointestinal endoscopy
- D-dimer
Investigations to consider
- mesenteric angiography
- mesenteric duplex ultrasound
- magnetic resonance angiography
- amylase
- studies for ova, cysts, and parasites
- faecal culture
- Clostridium difficile toxin assay
- abdominal x-rays
Treatment algorithm
evidence of infarction, perforation, or peritonitis on diagnostic computed tomography scan
no evidence of infarction, perforation, or peritonitis on diagnostic computed tomography scan
chronic mesenteric ischaemia
ischaemic colitis
non-acute colonic ischaemia
Contributors
Expert advisers
Jennifer Straatman
Consultant Upper GI surgeon
Queen Alexandra Hospital
Portsmouth
UK
Disclosures
JS declares that she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Alex von Roon, MB, ChB, PhD, FRCS
Clinical Senior Lecturer
Honorary Consultant Colorectal Surgeon
Department of Surgery and Cancer
Imperial College London
London
UK
James Lewis, MBBS, BSc, MRCS
Clinical Research Fellow
Department of Surgery and Cancer
Imperial College London
London
UK
John Abercrombie FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Disclosures
AVR and JL declare that they have no competing interests. JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.
Peer reviewers
Frances Howse, MA (Oxon), BM (Hons), FRCS (Eng)
Consultant
Acute and General Surgery
University Hospital Southampton NHS Foundation Trust
Southampton
UK
Disclosures
FH declares that she has no competing interests.
Editors
Emma Quigley
Section Editor, BMJ Best Practice
Disclosures
EQ declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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- Infectious colitis
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