Materiały źródłowe

• #1 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2778113/

  Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form. […] The diagnosis is based on a combination of clinical suspicion, radiographic, endoscopic and histological findings. […] Given that the presentation of colon ischemia is not specific and is highly variable, diagnosis and management is clinically challenging. Diagnosis requires a high index of clinical suspicion. […] The presence of diarrhea, abdominal pain and tenderness as well as mild lower gastrointestinal bleeding, even in the absence of any risk factor, should prompt consideration of IC as a cause. […] Early and repeated clinical evaluation in addition to radiological and endoscopic assessment is necessary to avoid complications.

• #1 Ischemic Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4442720/

  Most clinicians associate ischemic colitis with elderly patients who have underlying cardiovascular comorbidities. While the majority of cases probably occur in this population, the disease can present in younger patients as a result of different risk factors, making the diagnosis challenging. […] The classic presentation of ischemic colitis is an elderly patient presenting with bloody bowel movements, abdominal pain, and leukocytosis. Patients typically present with the acute onset of crampy abdominal pain and usually pass blood mixed with stool within 24 hours. […] Because of the nonspecific and vague nature of the symptoms, clinicians must maintain a high index of suspicion and actively inquire about comorbidities, medications, and drug use that may predispose patients to ischemic colitis.

• #1 Ischemic Colitis: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/

  While there is no current American College of Emergency Physicians guideline pertaining to ischemic colitis, an excellent guideline based upon nearly 200 resources has been offered by the American College of Gastroenterology (ACG). In this publication, the authors recommend diagnosis based upon the presence of symptoms consistent with IC (e.g. sudden cramping, mild abdominal pain, urgent desire to defecate, and passage of bright red or maroon blood or bloody diarrhea within 24 hours of the onset of symptoms). The certainty of this diagnosis is strengthened in the setting of the risk factors discussed above. […] The guideline also recommends extensive laboratory testing for the determination of prognosis and severity: Albumin, amylase, complete blood count, comprehensive electrolyte panel, creatinine kinase, lactate, lactate dehydrogenase (LDH). Low hemoglobin, less than 12 g/dl, or albumin levels less than 2.8 g/l, and the presence of acidosis, as indicated by lactate and LDH, indicate a more severe course. Stool studies serve to rule out infectious etiologies of the hematochezia which, if present, would decrease the clinical suspicion for IC.

• #1 Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

  https://www.mdpi.com/2075-4418/11/6/998

  Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. […] The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. […] The diagnosis arises from a combination of clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Sometimes, the clinical presentation is nonspecific or misleading, and it is difficult to distinguish among patients with possible infective, inflammatory, and IC. […] The diagnosis should be confirmed by colonoscopy (CS) and biopsy when possible, even if these procedures are considered unsafe in the acute phase. Guidance from the American College of Gastroenterology (ACG) recommends that computed tomography (CT), the diagnostic investigation of choice, is performed within the first few hours of admission.

• #1 Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

  https://www.mdcalc.com/guidelines/10374/acg/epidemiology-risk-factors-patterns-presentation-diagnosis-management-colon-ischemia-ci

  The diagnosis of CI is usually established in the presence of symptoms including sudden cramping, mild, abdominal pain; an urgent desire to defecate; and passage within 24 h of bright red or maroon blood or bloody diarrhea. […] A diagnosis of non-isolated right colon ischemia (non-IRCI) should be considered when patients present with hematochezia. […] CT with intravenous and oral contrast should be the first imaging modality of choice for patients with suspected CI to assess the distribution and phase of colitis. […] The diagnosis of CI can be suggested based on CT findings (e.g., bowel wall thickening, edema, thumbprinting). […] Multiphasic CTA should be performed on any patient with suspected IRCI or in any patient in whom the possibility of AMI cannot be excluded. […] CT or MRI findings of colonic pneumatosis and porto-mesenteric venous gas can be used to predict the presence of transmural colonic infarction.

• #1 Ischemic Colitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366808-overview

  CT is the single best test after plain radiography because it can exclude many other causes of abdominal pain and can also establish the diagnosis of intestinal ischemia. […] MRI may be useful in depicting bowel wall changes and in demonstrating mesenteric vascular abnormalities. […] Ultrasonography is a sensitive yet noninvasive technique that may provide useful information about mesenteric ischemia.

• #1 Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

  https://www.mdpi.com/2075-4418/11/6/998

  In practice, ultrasound (US) and abdominal X-ray (XR) may sometimes represent the imaging modalities at patient admission for the investigation of abdominal pain, but these imaging methods have no role in directly diagnosing IC. […] CT gives prompt information, with positive findings in ischemic colitis in up to 98% of cases. […] The American College of Radiology (ACR) guidelines recommend CT as the first imaging technique as an alternative to mesenteric angiography for the assessment of IC. […] In the diagnosis of IC, it is important to indicate the etiology (arterial ischemic, non-occlusive, reperfusive, venous); the location and extension of the intestinal damage; the phase of the damage (acute, subacute or chronic). […] Colonoscopy is considered the test of choice in confirming the diagnosis of IC, due to its high sensitivity. An early colonoscopy is suggested by ACG guidelines within 48 h of IC presentation, with minimal insufflations and stopping at the most distal extent of the disease.

• #1 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2778113/

  Colonoscopy has replaced barium enema as the most common diagnostic method and the gold standard for confirmation of IC. […] Diagnosis requires early colonoscopy ( 48 h). […] The initial diagnostic study should be performed soon after the onset of symptoms. […] In chronic stages, weeks or months later, stricture, mucosal atrophy and granularity or a mucosal pattern suggestive of segmental ulcerative colitis may occur. […] The etiology of ischemic colitis is multifactorial and the clinical presentation variable. The diagnosis is based on a combination of clinical suspicion, endoscopic and histological findings.

• #1 Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

  https://www.mdcalc.com/guidelines/10374/acg/epidemiology-risk-factors-patterns-presentation-diagnosis-management-colon-ischemia-ci

  In a patient in whom the presentation of CI may be a heralding sign of AMI (e.g., IRCI, severe pain without bleeding, atrial fibrillation), and the multiphasic CT is negative for vascular occlusive disease, traditional splanchnic angiography should be considered for further assessment. […] Early colonoscopy (within 48 h of presentation) should be performed in suspected CI to confirm the diagnosis. […] When performing colonoscopy on a patient with suspected CI, the colon should be insufflated minimally. […] In patients with severe CI, CT should be used to evaluate the distribution of disease. Limited colonoscopy is appropriate to confirm the nature of the CT abnormality. Colonoscopy should be halted at the distalmost extent of the disease. […] Biopsies of the colonic mucosa should be obtained except in cases of gangrene. […] Colonoscopy should not be performed in patients who have signs of acute peritonitis or evidence of irreversible ischemic damage (i.e., gangrene and pneumatosis).

• #1 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed by endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter (see Diagnosis). […] There are devices which test the sufficiency of oxygen delivery to the colon. The first device approved by the U.S. FDA in 2004 uses visible light spectroscopy to analyze capillary oxygen levels. […] There is a recent optical test, but it requires endoscopy (see Diagnosis). There are no specific blood tests for ischemic colitis. […] Endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the procedure of choice if the diagnosis remains unclear. Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate diagnoses such as infection or inflammatory bowel disease. Biopsies can be taken via endoscopy to provide more information. Visible light spectroscopy, performed using catheters placed through the 5 mm channel of the endoscope, is diagnostic (see Diagnosis).

• #1 Ischemic Colitis – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/ischemic-colitis

  Ischemic colitis is injury of the large intestine that results from an interruption of blood flow. […] Computed tomography is usually done, and colonoscopy is sometimes done. […] A doctor may suspect ischemic colitis on the basis of the symptoms of pain and bleeding, especially in a person older than 60. It is important for doctors to distinguish ischemic colitis from acute mesenteric ischemia, a more dangerous condition in which blood flow to part of the intestine can become completely and irreversibly blocked. […] Doctors usually do CT or sometimes also colonoscopy (examination of the large intestine with a flexible viewing tube) to distinguish ischemic colitis from other forms of inflammation, such as infection or inflammatory bowel disease.

• #1 Ischemic colitis – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/gastroenterology-hepatology/ischemic-colitis/

  Although colonoscopy is the main diagnostic test today, it may not show conclusive results. Biopsies should be obtained to characterize the disease and its segmental nature. Biopsies consistent with ischemic colitis might show subepithelial hemorrhage and edema, iron-laden macrophages, and submucosal fibrosis; only gangrene provides the diagnosis. […] It is most important to refer to a gastroenterologist and/or surgeon when patients present with an acute abdomen, the physical exam is remarkable for pain out of proportion to the exam, and the patient has blood work remarkable for an elevated lactate, lactate dehydrogenase, creatine kinase, substantial leukocytosis, or metabolic acidosis. […] Patients who have severe abdominal pain, persistent bloody diarrhea, are hemodynamically unstable, or have any signs of bowel perforation or infarction should be hospitalized. All elderly patients presenting with symptoms consistent with ischemic colitis should be hospitalized and managed conservatively for 24 hours.

• #1 Emerging Diagnostic Markers in Acute Ischemic Colitis

  https://scholarlycommons.henryford.com/hospitalmedicine_mtgabstracts/45/

  Colonic ischemia should be suspected in patients admitted for heart failure with lower abdominal pain and bloody diarrhea or hematochezia. […] The diagnosis and treatment of colonic ischemia can be challenging since it often occurs in patients who are debilitated with multiple medical problems. […] There is a lack of established biomarkers to help identify acute intestinal ischemia, although several have been investigated in the past. […] There is a few promising biomarkers with high specificity that may become a potential tool in early diagnosis of acute intestinal ischemia including intestinal fatty acid binding protein (I-FABP), a-glutathione S-transferase (a-GST), D-dimer, L- and D-lactate, citrulline, ischemia modified albumin, and procalcitonin (PCT). […] These markers are not only promising because of the high specificity, but also because they can be measured rapidly which will not delay diagnosis of acute intestinal ischemia.

• #1 Ischemic colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischaemic-colitis?lang=us

  Contrast enhanced imaging (ideally with an arterial phase) is the modality of choice. […] Secondary findings supportive of an ischemic etiology include the presence of parenchymal ischemia/infarction in other abdominal organs, such as the liver, kidneys, and spleen. […] Mesenteric arterial or venous occlusion can be treated with anticoagulation or thrombolysis, either systemically or locally. Surgical resection is indicated in cases of peritonitis, perforation, severe sepsis and massive hemorrhage. […] Prognosis is variable: resolution without ongoing complications ~50%, persistent colitis ~20%, ischemic stricture ~10%, gangrene or perforation ~20%.

• #1 Ischemic colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischaemic-colitis?embed_domain=hackmd.io%2525252F%25252540yIPUAFeCSL2JsU8smR5nJQ%2525252Fbnjhjgjghjghjghfavicon.ico&lang=us

  Contrast enhanced imaging (ideally with an arterial phase) is the modality of choice. […] Secondary findings supportive of an ischemic etiology include the presence of parenchymal ischemia/infarction in other abdominal organs, such as the liver, kidneys, and spleen. […] Prognosis is variable: resolution without ongoing complications ~50%, persistent colitis ~20%, ischemic stricture ~10%, gangrene or perforation ~20%. Occlusive mesenteric infarction (embolus or thrombosis) has a high mortality rate (~90%) compared to non-occlusive ischemia (~10%).

• #1 Ischemic colitis as a cause of severe hematochezia: A mini review

  https://www.probiologists.com/article/ischemic-colitis-as-a-cause-of-severe-hematochezia-a-mini-review

  Higher disease-specific mortality rates are reported in patients with multiorgan failure. […] In patients with Faviers stage III and multiorgan failure, the mortality rate was 65.8% compared to 16.6% without multiorgan failure. […] For IC with severe hematochezia, more evidence-based data on primary prevention, early diagnosis, effective pharmacological treatment, and endoscopic hemostasis are lacking but needed to improve patient outcomes.

• #1 Ischemic colitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ischemic-colitis/diagnosis-treatment/drc-20374005

  Ischemic colitis can often be confused with other conditions because their symptoms overlap, especially inflammatory bowel disease (IBD). Based on symptoms, a healthcare professional may recommend these imaging tests: […] Colonoscopy. This test, which provides detailed images of the colon, can be helpful in diagnosing ischemic colitis. Colonoscopy also can be used to check for cancer, and to see how well a treatment worked. A tissue sample, called a biopsy, may be collected to help make a diagnosis. […] A care professional also may schedule follow-up colonoscopies to monitor healing and look for complications. […] What kinds of tests do I need?

• #1 Ischemic colitis – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/gastroenterology-hepatology/ischemic-colitis/

  The clinician must always consider that patients with ischemic colitis might form a stricture or develop chronic colitis. Stricture formation might present in a variety of ways including constipation, narrowing caliber of stool, or large bowel obstruction. This can be assessed with either a CT scan or barium enema. If a patients stricture is clinically significant surgical resection may be indicated. […] Patients with mild episodes of ischemic colitis can usually follow up with their physician within 1 month. During patient follow-up, the clinician should ask the patient about his/her bowel habits, the presence or absence of blood in stool, and abdominal pain. Persistent diarrhea or blood in the stool might indicate another disease process. It is usually not necessary to repeat colonoscopy to assess healing if the patient has no symptoms of colitis.

• #2 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v14/i48/7302.htm

  Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form. […] The diagnosis is based on a combination of clinical suspicion, radiographic, endoscopic and histological findings. […] Given that the presentation of colon ischemia is not specific and is highly variable, diagnosis and management is clinically challenging. Diagnosis requires a high index of clinical suspicion. […] The presence of diarrhea, abdominal pain and tenderness as well as mild lower gastrointestinal bleeding, even in the absence of any risk factor, should prompt consideration of IC as a cause. […] Early and repeated clinical evaluation in addition to radiological and endoscopic assessment is necessary to avoid complications.

• #2 Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

  https://www.mdcalc.com/guidelines/10374/acg/epidemiology-risk-factors-patterns-presentation-diagnosis-management-colon-ischemia-ci

  The diagnosis of CI is usually established in the presence of symptoms including sudden cramping, mild, abdominal pain; an urgent desire to defecate; and passage within 24 h of bright red or maroon blood or bloody diarrhea. […] A diagnosis of non-isolated right colon ischemia (non-IRCI) should be considered when patients present with hematochezia. […] CT with intravenous and oral contrast should be the first imaging modality of choice for patients with suspected CI to assess the distribution and phase of colitis. […] The diagnosis of CI can be suggested based on CT findings (e.g., bowel wall thickening, edema, thumbprinting). […] Multiphasic CTA should be performed on any patient with suspected IRCI or in any patient in whom the possibility of AMI cannot be excluded. […] CT or MRI findings of colonic pneumatosis and porto-mesenteric venous gas can be used to predict the presence of transmural colonic infarction.

• #2 Ischemic Colitis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/ischemic-colitis

  How is ischemic colitis diagnosed? IC can be hard to diagnose. It can easily be mistaken for inflammatory bowel disease, a group of diseases that includes Crohns disease and ulcerative colitis. Your doctor will ask you about your medical history and order several diagnostic tests. These tests can include the following: An ultrasound or CT scan can create images of your blood vessels and intestines. A mesenteric angiogram is an imaging test that uses X-rays to see inside your arteries and determine the location of the blockage. A blood test can check for a white blood cell count. If your white blood cell count is high, it may indicate acute IC. […] The outlook for people with acute IC is often poor because tissue death in the intestine frequently occurs before surgery. The outlook is much better if you receive a diagnosis and start treatment right away.

• #2 Ischemic Colitis: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/

  The ACG recommends a CT of the abdomen with intravenous and oral contrast as the first choice for the diagnosis of IC given its ability to assess the phase (acute, subacute, or chronic) and distribution of the colitis. Findings of bowel wall thickening, edema, and thumbprinting on CT suggest IC. Colonic pneumatosis and portomesenteric venous gas are more specific and indicate more severe disease. […] In the hemodynamically stable patient with IC risk factors and no indications for immediate surgical intervention (hematochezia/melena, peritoneal signs, or evidence of severe disease on imaging) colonoscopy is recommended within 48 hours of presentation to confirm the diagnosis. Patients with IC should be admitted for optimization of underlying medical conditions as well as a colonoscopy to confirm the diagnosis.

• #2 Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

  Ischemic colitis is a master of disguise. Its symptoms can mimic other conditions, including a flare of ulcerative colitis or Crohns disease. Those long-lasting conditions result from a problem with your immune system, not low blood flow. […] Doctors may ask for any of these tests to decide if you have ischemic colitis: […] CT scans use X-rays at different angles to get a detailed image of your colon and blood vessels. A CT of your abdomen is usually the first imaging test doctors order if you have symptoms of ischemic colitis. If you have pain on your right side, CT angiograms can help your doctor figure out whether its from ischemic colitis or AMI. […] Colonoscopy. This test looks inside your colon. The doctor also may take tissue samples to confirm a diagnosis. Colonoscopy with biopsy is considered the gold standard to definitively diagnose ischemic colitis. Its often used for people with ongoing or chronic ischemic colitis. […] Blood tests. These cant diagnose ischemic colitis. But they can check for proteins linked to intestinal damage and for blood clotting issues.

• #2 Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review

  https://www.mdpi.com/2075-4418/11/6/998

  In practice, ultrasound (US) and abdominal X-ray (XR) may sometimes represent the imaging modalities at patient admission for the investigation of abdominal pain, but these imaging methods have no role in directly diagnosing IC. […] CT gives prompt information, with positive findings in ischemic colitis in up to 98% of cases. […] The American College of Radiology (ACR) guidelines recommend CT as the first imaging technique as an alternative to mesenteric angiography for the assessment of IC. […] In the diagnosis of IC, it is important to indicate the etiology (arterial ischemic, non-occlusive, reperfusive, venous); the location and extension of the intestinal damage; the phase of the damage (acute, subacute or chronic). […] Colonoscopy is considered the test of choice in confirming the diagnosis of IC, due to its high sensitivity. An early colonoscopy is suggested by ACG guidelines within 48 h of IC presentation, with minimal insufflations and stopping at the most distal extent of the disease.

• #2 Ischemic Colitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366808-overview

  Ischemic colitis encompasses a number of clinical entities, all with an end result of insufficient blood supply to a segment or the entire colon. This disease results in ischemic necrosis of varying severity that can range from superficial mucosal involvement to full-thickness transmural necrosis. […] Colonoscopy along with histopathologic biopsy is the current standard modality for diagnosis. […] Cocaine-induced ischemic colitis is a recognized entity, and the diagnosis is based on clinical and endoscopic findings. Diagnostic imaging is helpful for evaluating abdominal symptoms, and previous studies have suggested specific sonographic findings in ischemic colitis. […] A reliable diagnosis of ischemic colitis can be made only when the radiologic findings are correlated with the clinical results.

• #2 Ischemic colitis: Clinical practice in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v14/i48/7302.htm

  Colonoscopy has replaced barium enema as the most common diagnostic method and the gold standard for confirmation of IC. […] Diagnosis requires early colonoscopy ( 48 h). […] The initial diagnostic study should be performed soon after the onset of symptoms. […] The etiology of ischemic colitis is multifactorial and the clinical presentation variable. The diagnosis is based on a combination of clinical suspicion, endoscopic and histological findings.

• #2

  https://link.springer.com/article/10.1007/s11894-005-0013-1

  The clinical presentation and outcome of ischemic colitis has a wide spectrum. Impaired perfusion of blood to the bowel from a variety of causes is the underlying pathophysiology. The presence of diarrhea, abdominal pain, and mild lower gastrointestinal bleeding should prompt consideration of ischemic colitis as a cause. […] Although many laboratory tests and radiographic images may suggest the diagnosis, endoscopic visualization of colonic mucosa with histologic analysis of biopsies is the gold standard for identification of colonic ischemia. […] Thus, surgical resection of the affected segment should be considered early to minimize adverse outcomes. This review describes the etiology, pathophysiology, clinical features, diagnostic approach, and management of ischemic colitis.

• #2 Ischemic colitis – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/gastroenterology-hepatology/ischemic-colitis/

  Although colonoscopy is the main diagnostic test today, it may not show conclusive results. Biopsies should be obtained to characterize the disease and its segmental nature. Biopsies consistent with ischemic colitis might show subepithelial hemorrhage and edema, iron-laden macrophages, and submucosal fibrosis; only gangrene provides the diagnosis. […] It is most important to refer to a gastroenterologist and/or surgeon when patients present with an acute abdomen, the physical exam is remarkable for pain out of proportion to the exam, and the patient has blood work remarkable for an elevated lactate, lactate dehydrogenase, creatine kinase, substantial leukocytosis, or metabolic acidosis. […] Patients who have severe abdominal pain, persistent bloody diarrhea, are hemodynamically unstable, or have any signs of bowel perforation or infarction should be hospitalized. All elderly patients presenting with symptoms consistent with ischemic colitis should be hospitalized and managed conservatively for 24 hours.

• #2 Ischemic colitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ischemic-colitis/symptoms-causes/syc-20374001

  Ischemic colitis can be hard to diagnose because it can easily be confused with other digestive problems. […] Contact a healthcare professional if you have symptoms that worry you, such as bloody diarrhea. Early diagnosis and treatment can help prevent serious complications.

• #2 Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

  https://www.mdcalc.com/guidelines/10374/acg/epidemiology-risk-factors-patterns-presentation-diagnosis-management-colon-ischemia-ci

  In a patient in whom the presentation of CI may be a heralding sign of AMI (e.g., IRCI, severe pain without bleeding, atrial fibrillation), and the multiphasic CT is negative for vascular occlusive disease, traditional splanchnic angiography should be considered for further assessment. […] Early colonoscopy (within 48 h of presentation) should be performed in suspected CI to confirm the diagnosis. […] When performing colonoscopy on a patient with suspected CI, the colon should be insufflated minimally. […] In patients with severe CI, CT should be used to evaluate the distribution of disease. Limited colonoscopy is appropriate to confirm the nature of the CT abnormality. Colonoscopy should be halted at the distalmost extent of the disease. […] Biopsies of the colonic mucosa should be obtained except in cases of gangrene. […] Colonoscopy should not be performed in patients who have signs of acute peritonitis or evidence of irreversible ischemic damage (i.e., gangrene and pneumatosis).

• #2 Ischemic Colitis Presented as Pseudomembranous Colitis: An Untypical Case from Vietnam

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2022.023

  Ischemic colitis (IC) is an underreported chronic disease characterized by the hypoperfusion of the bowel mucosa. The diagnosis and treatment may be challenging because its clinical course resembles other colitis or even colorectal malignancies. […] A diagnosis of IC is based on multi-aspects (history, physical examination, risk factors, imaging modalities, endoscopic and pathologic evidence). […] Colonoscopy has been regarded as the gold standard diagnostic approach by directly observing the colonic mucosa and obtaining biopsy specimens, which can overcome the difficulty of recognizing IC. […] The endoscopic examination revealed nonspecific pseudomembranous colitis with ulcers from the rectum to the splenic flexure. […] The microscopic features from colonic specimens were collected during the colonoscopy and surgery to differentiate IC from CDI-associated colitis and other types of colitis.

• #2 Ischemic colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischaemic-colitis?embed_domain=hackmd.io%2525252F%25252540yIPUAFeCSL2JsU8smR5nJQ%2525252Fbnjhjgjghjghjghfavicon.ico&lang=us

  Contrast enhanced imaging (ideally with an arterial phase) is the modality of choice. […] Secondary findings supportive of an ischemic etiology include the presence of parenchymal ischemia/infarction in other abdominal organs, such as the liver, kidneys, and spleen. […] Prognosis is variable: resolution without ongoing complications ~50%, persistent colitis ~20%, ischemic stricture ~10%, gangrene or perforation ~20%. Occlusive mesenteric infarction (embolus or thrombosis) has a high mortality rate (~90%) compared to non-occlusive ischemia (~10%).

• #2 Ischemic colitis as a cause of severe hematochezia: A mini review

  https://probiologists.com/Article/Ischemic-colitis-as-a-cause-of-severe-hematochezia:-A-mini-review

  In patients with Faviers stage III and multiorgan failure, the mortality rate was 65.8% compared to 16.6% without multiorgan failure. […] No mortality was reported among patients with Faviers stage I. […] Management of IC depends upon the severity of IC and patients clinical status. […] The majority of IC patients have non-transmural injury, transient colitis, and reversible colopathy. […] They can be successfully managed with medical treatment. […] Colonoscopic hemostasis using hemoclip is safe in selected patients with focal ischemic ulcers and major SRH. […] A small percentage of these patients with severe bleeding and advanced stage IC require surgery. […] However, some patients who are referred for surgery but are not surgical candidates due to multiple severe comorbidities. […] Clinical outcomes in those undergoing colon surgeries for IC and those who are not surgical candidates are significantly worse than in those treated medically. […] Also, patients with outpatient start of hematochezia have better clinical outcomes than those with inpatient start of bleeding.

• #3 Ischemic Colitis – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/ischemic-colitis

  Ischemic colitis is injury of the large intestine that results from an interruption of blood flow. […] Computed tomography is usually done, and colonoscopy is sometimes done. […] A doctor may suspect ischemic colitis on the basis of the symptoms of pain and bleeding, especially in a person older than 60. It is important for doctors to distinguish ischemic colitis from acute mesenteric ischemia, a more dangerous condition in which blood flow to part of the intestine can become completely and irreversibly blocked. […] Doctors usually do CT or sometimes also colonoscopy (examination of the large intestine with a flexible viewing tube) to distinguish ischemic colitis from other forms of inflammation, such as infection or inflammatory bowel disease.

• #3 Ischemic Colitis – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/ischemic-colitis

  Ischemic colitis is a transient reduction in blood flow to the colon. Diagnosis is by CT or colonoscopy. […] Diagnosis of ischemic colitis is made by CT or colonoscopy. […] Angiography or magnetic resonance angiography is not indicated.

• #3 Ischemic Colitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/366808-overview

  CT is the single best test after plain radiography because it can exclude many other causes of abdominal pain and can also establish the diagnosis of intestinal ischemia. […] MRI may be useful in depicting bowel wall changes and in demonstrating mesenteric vascular abnormalities. […] Ultrasonography is a sensitive yet noninvasive technique that may provide useful information about mesenteric ischemia.

• #3 Ischemic Colitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4442720/

  Colonoscopy remains the most sensitive and specific study available for the diagnosis of ischemic colitis because it allows for detection of mucosal changes by directly visualizing the mucosa. […] Once the diagnosis of ischemic colitis has been made, patients should be aggressively resuscitated and receive broad-spectrum intravenous antibiotics. […] The combination of vague symptoms and physical findings, and nonspecific laboratory and radiographic results can make the diagnosis of ischemic colitis challenging to even the most seasoned clinicians. Recognizing risk factors in younger patients and maintaining a high index of suspicion is essential to institute timely care. The majority of patients respond to medical management. Surgery (colectomy), when required, is associated with a high morbidity and mortality rate.

• #3 Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

  https://www.mdcalc.com/guidelines/10374/acg/epidemiology-risk-factors-patterns-presentation-diagnosis-management-colon-ischemia-ci

  In a patient in whom the presentation of CI may be a heralding sign of AMI (e.g., IRCI, severe pain without bleeding, atrial fibrillation), and the multiphasic CT is negative for vascular occlusive disease, traditional splanchnic angiography should be considered for further assessment. […] Early colonoscopy (within 48 h of presentation) should be performed in suspected CI to confirm the diagnosis. […] When performing colonoscopy on a patient with suspected CI, the colon should be insufflated minimally. […] In patients with severe CI, CT should be used to evaluate the distribution of disease. Limited colonoscopy is appropriate to confirm the nature of the CT abnormality. Colonoscopy should be halted at the distalmost extent of the disease. […] Biopsies of the colonic mucosa should be obtained except in cases of gangrene. […] Colonoscopy should not be performed in patients who have signs of acute peritonitis or evidence of irreversible ischemic damage (i.e., gangrene and pneumatosis).

• #3 Ischemic Colitis -The Gastrointestinal Atlas – gastrointestinalatlas.com

  https://www.gastrointestinalatlas.com/english/ischemic_colitis.html

  Severe case of Ischemic Colitis. This patient was successfully treated by surgery. […] Discrepancy between subjective symptoms and objective findings is a hallmark of ischemic colitis. Thus, diagnosis requires a high index of suspicion in the appropriate clinical setting. […] The diverse causes, variable clinical presentations, and severity makes the diagnosis and management of ischemic colitis a challenge. […] Ischemic colitis is the second or third most common cause of lower gastrointestinal bleeding. […] Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. […] There are no endoscopic findings that are specific for ischemia, thus the clinical setting must be considered. […] Ischemic colitis occurs as the result of a compromise in intestinal blood flow that can produce a spectrum of injury from transient self-limited ischemia to fulminant ischemia or transmural infarction. Its diagnosis requires a high index of suspicion, and the clinician should consider the diagnosis in patients with acute abdominal pain and bloody stools.

• #3 Ischemic Colitis: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/

  Ischemic colitis (IC) is the underlying etiology in 16-24% of acute lower gastrointestinal bleeds (LGIBs). As individuals with IC often present with non-specific symptoms, approximately 80% of cases are missed during the initial patient encounter. In the ED, IC is correctly diagnosed in only 9% of the cases (when compared to final inpatient diagnoses). With a 10-15% mortality rate and increasing incidence in the U.S., IC is a diagnosis that should not be missed. […] Symptoms usually include acute abdominal pain, mild rectal bleeding, and diarrhea. In cases of isolated right colon ischemia, patients often present with abdominal pain in the absence of hematochezia or melena. Abdominal pain was one of the clinical features in approximately 87% of patients with IC. While rectal bleeding was present in 84% and diarrhea in 57% according to a study that retrospectively analyzed hospital stays of patients who were discharged with International Classification of Diseases codes that were consistent with IC. Both abdominal pain and rectal bleeding occurred in 72% of the hospitalizations analyzed. The differential diagnosis for abdominal pain and bloody diarrhea is broad with infection, diverticulosis, hemorrhoids, neoplasia, inflammatory bowel disease, and vascular ectasia all representing causes of LGIB. Distinguishing between these conditions based upon history, physical exam, laboratory testing, and imaging is frequently necessary.

• #3 Ischemic Colitis: ED Presentations, Evaluation, and Management – emDocs

  https://www.emdocs.net/ischemic-colitis-ed-presentations-evaluation-and-management/

  The ACG recommends a CT of the abdomen with intravenous and oral contrast as the first choice for the diagnosis of IC given its ability to assess the phase (acute, subacute, or chronic) and distribution of the colitis. Findings of bowel wall thickening, edema, and thumbprinting on CT suggest IC. Colonic pneumatosis and portomesenteric venous gas are more specific and indicate more severe disease. […] In the hemodynamically stable patient with IC risk factors and no indications for immediate surgical intervention (hematochezia/melena, peritoneal signs, or evidence of severe disease on imaging) colonoscopy is recommended within 48 hours of presentation to confirm the diagnosis. Patients with IC should be admitted for optimization of underlying medical conditions as well as a colonoscopy to confirm the diagnosis.

• #3 Ischemic Colitis Presented as Pseudomembranous Colitis: An Untypical Case from Vietnam

  https://www.kjg.or.kr/journal/view.html?doi=10.4166/kjg.2022.023

  In particular, in PMC, the presence of a hyalinized lamina propria was both a sensitive and specific diagnostic for IC. […] In summary, in tropical areas, the coexistence of infectious colitis can aggravate a preexisting ischemic condition. […] Raising physician awareness and vigilance about this disease is critical for establishing an early diagnosis and prompt management, particularly in elderly individuals presenting with abdominal pain, chronic diarrhea, rectal bleeding, and the presence of comorbid disease.

• #4

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] Colonoscopy combined with histopathological biopsy is the standard of diagnosis for the IC. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #4 Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

  Ischemic colitis is a master of disguise. Its symptoms can mimic other conditions, including a flare of ulcerative colitis or Crohns disease. Those long-lasting conditions result from a problem with your immune system, not low blood flow. […] Doctors may ask for any of these tests to decide if you have ischemic colitis: […] CT scans use X-rays at different angles to get a detailed image of your colon and blood vessels. A CT of your abdomen is usually the first imaging test doctors order if you have symptoms of ischemic colitis. If you have pain on your right side, CT angiograms can help your doctor figure out whether its from ischemic colitis or AMI. […] Colonoscopy. This test looks inside your colon. The doctor also may take tissue samples to confirm a diagnosis. Colonoscopy with biopsy is considered the gold standard to definitively diagnose ischemic colitis. Its often used for people with ongoing or chronic ischemic colitis. […] Blood tests. These cant diagnose ischemic colitis. But they can check for proteins linked to intestinal damage and for blood clotting issues.

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