Ischemic Colitis

Red

Step 1: View clinicals

A 75 year old man presents with mild cramping pain in the left lower abdomen for 1 day. During the same time, he twice passed stools well mixed with fresh blood. His surgical history is significant for removal of a single adenomatous polyp during a screening colonoscopy 2 years ago. In addition, he was diagnosed with hypertension 5 years ago, and stage III chronic kidney disease 3 years ago, for which he is being followed up regularly. His smoking history amounts to 7.5 pack years. He only drinks socially and denies recreational drug abuse. A complete blood count reveals a leukocyte count of 12,000/mm3.


Step 2: Order all relevant investigations

Barium Enema

You realize that a barium enema might not be a good idea.

Colonoscopy

Colonoscopy reveals a large, necrotic-appearing mass occupying most of the descending colon, from which multiple biopsies are obtained. The biopsy specimen is significant for necrotic colonic mucosa, fibrinopurulent exudates, partially viable tissue, and changes which favor mucosal infarction. There are no features suggestive of malignancy.

Mesenteric Angiography

The mesenteric arterial system appears completely normal.

Diagnostic Laparoscopy

You realize that diagnostic laparoscopy is probably not indicated right now.


Step 3: Select appropriate management

Urgent Surgery
Systemic Corticosteroids
Rest the Bowel
Broad Spectrum Antibiotics


Score: ★★☆