AM report pearls 5/9: ischemic colitis!


Take-home pearl #1: whenever somebody presents with SUDDEN ONSET abdominal pain, think about ischemia and perforation at the top of your differential!

Take-home pearl #2: remember that antibiotics in the context of EHEC (E coli O157:H7) can cause HUS!


When thinking through a differential for bloody diarrhea, think about infectious (eg Shigella, Salmonella, enteroinvasive E coli, Entamoeba) and non-infectious causes. Among non-infectious causes, think about ischemic, IBD, malignancy (leading to vessel erotion).

  • For ischemic colitis, consider:
    • Thromboembolic disease
    • Vasculitis
    • Vasospasm (abdominal migraine)
    • Hypoperfusion (esp in watershed regions, eg splenic flexure)
    • NSAIDs?
  • Thank you to several of you for some great additional learning points on ischemic colitis:
    • Thank you to Geoff for sharing that 74% of patients with unexplained ischemic colitis have undiagnosed protein C/S deficiency!
    • Thank you to Rabih for sharing this article on localization patterns of ischemic colitis – “in patients being treated with NSAIDs, ischemic colitis was observed significantly more often in the right hemicolon”
    • Thank you to David for sharing the attached article on ACG guidelines for treatment of ischemic colitis as stratified by mild/mod/severe disease! Link is here. For moderate ischemic colitis, management includes:
      • Aggressive IVF
      • Antibiotics (to reduce risk of gut translocation)
      • Surgery if complete vessel occlusion, perforation
      • Early colonoscopy
      • *note: antithrombotic therapy is not indicated for most patients with colonic ischemia as the majority of patients have nonocclusive ischemia! But, if a thromboembolic event is found, then will want to w/u for cause (eg hypercoagulability w/u) and anticoagulation is indicated
    • *20-30% recurrent of ischemic colitis within 5 years!
    • ischemic colitis.png

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