- Consider ischemic colitis as the possible cause of acute-onset abdominal pain with rectal bleeding in patients age 50 and older with cardiovascular morbidities.
- For patients with peritoneal signs, radiographs should be considered for evaluation of ileus (air fluid levels), thumbprinting, pneumatosis coli, or pneumoperitoneum.
- Consider ordering a CTA as first-line imaging, especially if there is any suggestion of mesenteric ischemia, right sided tenderness without hematochezia, or if you suspect severe disease. If resources do not allow, order a CT with oral and IV contrast. If IRCI is incidentally found on initial CT, then CTA can be deferred to the inpatient setting and obtained prior to discharge.
- Give antibiotics in suspected ischemic colitis if the patient has any of the factors associated with severe disease.
- Place an emergent surgical consultation for any patient with peritoneal signs on physical exam or pneumatosis coli, portal venous gas, pan-colonic distribution, or isolated right-colon ischemia on imaging.
- Shannon Thompson. Ischemic Colitis: ED Presentations, Evaluation, and Management emDOCs.net Permission to reproduce via Creative Commons Attribution 4.0 International License per emDOCS.net