Colon Ischemia

Question 1

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 hours of bright red or maroon blood or bloody diarrhea

Answer 1

strong, very low evidence

Question 2

Diagnosis of non-isolated right colon ischemia should be considered when patients present with hematochezia

Answer 2

strong, very low evidence

Question 3

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

Answer 3

strong, moderate evidence

Question 4

The diagnosis of CI can be suggested based on CT findings

Answer 4

strong, moderate evidence

Question 5

Multiphasic CTA should be performed on any patient with suspected IRCI or in any patient in whom the possibility of AMI cannot be excluded

Answer 5

strong, moderate evidence

Question 6

CT or MRI findings of colonic pneumatosis and de porto-mesenteric venous gas can be used to predict the presence of transmural colonic infarction

Answer 6

strong, moderate evidence

Question 7

In a patient in whom the presentation of CI may be a heralding sign of AMI and the multiphasic CT is negative for vascular occlusive disease, traditional splenic angiography should be considered for further assessment

Answer 7

conditional, low evidence

Question 8

Early colonoscopy within 48 hours of presentation should be performed in suspected CI to confirm diagnosis

Answer 8

strong, low evidence

Question 9

When performing colonoscopy on a patient with suspected CI, the colon should be insufflated minimally

Answer 9

conditional, very low evidence

Question 10

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 distal most extent of the disease.

Answer 10

strong, low evidence

Question 11

Biopsies of the colonic mucosa should be obtained except in cases of gangrene

Answer 11

strong, very low evidence

Question 12

Colonoscopy should not be performed in patients who have signs of acute peritonitis or evidence of irreversible ischemic damage

Answer 12

strong, very low evidence

Question 13

Most cases of CI resolved spontaneously do not require specific therapy

Answer 13

strong, low evidence

Question 14

Surgical intervention should be considered in the presence of CI accompanied by hypotension, comma, tachycardia, comma, and abdominal pain without rectal bleeding, period, for RCI and pancolonic CI and in the presence of gangrene

Answer 14

strong, moderate evidence

Question 15

Antimicrobial therapy should be considered for patients with moderate or severe disease

Answer 15

strong, very low evidence

Question 16

Risk factors

Answer 16

1. Comorbid cardiovascular disease and diabetes mellitus should be increased consideration of CI in patients with typical clinical features.
2. A history of IBS and constipation should be sought in patients suspected to have CI.
3. Selective cardiology consultation is justified in patients with CI, particularly if a cardiac source of embolism is suspected.
4. Chronic kidney disease is associated with increased mortality from CI.
5. Evaluation for thrombophilia should be considered in young patients with CI and all patients with recurrent CI.
6. Surgical procedures in which the inferior mesenteric artery has been sacrificed, such as an abdominal aortic aneurysm repair and other abdominal operations, should increase consideration of CI in patients with typical clinical features.
7. In patients suspected of having CI, history of medication and drug use is important, especially constipation-inducing medications, immunomodulators, and illicit drugs.