Emergency: requires immediate attention
Ischemic colitis
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Synopsis

Ischemic colitis is defined by a compromise in blood flow to the colon that leads to ischemic injury, which can result in mucosal ulceration, hemorrhage, and potentially perforation. Hypoperfusion is the most common etiology, leading to nonocclusive colonic ischemia. This occurs most frequently in the watershed regions, which have limited collateral blood supply. Ischemic colitis may also be due to occlusive thrombi in the mesenteric arteries or veins, especially in older individuals with comorbidities such as cardiovascular disease.
The incidence of ischemic colitis is at least 16 per 100 000 people / year; however, the true incidence is likely greater, as many people may not recognize the transient symptoms of ischemic colitis. It is believed that colonic ischemia may be more prevalent in women.
Typical presenting symptoms include lower abdominal pain and bloody diarrhea. The presentation can be acute or chronic (more often involving the rectum). Risk factors for the development of ischemic colitis include smoking, atherosclerosis, aortoiliac surgery, myocardial infarction, hemodialysis, and hypercoagulable state.
The incidence of ischemic colitis is at least 16 per 100 000 people / year; however, the true incidence is likely greater, as many people may not recognize the transient symptoms of ischemic colitis. It is believed that colonic ischemia may be more prevalent in women.
Typical presenting symptoms include lower abdominal pain and bloody diarrhea. The presentation can be acute or chronic (more often involving the rectum). Risk factors for the development of ischemic colitis include smoking, atherosclerosis, aortoiliac surgery, myocardial infarction, hemodialysis, and hypercoagulable state.
Codes
ICD10CM:
K55.9 – Vascular disorder of intestine, unspecified
SNOMEDCT:
30588004 – Ischemic colitis
K55.9 – Vascular disorder of intestine, unspecified
SNOMEDCT:
30588004 – Ischemic colitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Infectious colitis (eg, caused by Salmonella, Shigella, Campylobacter, Mycobacterium tuberculosis, invasive Escherichia coli, and Yersinia; Clostridioides difficile colitis, amebic colitis)
- Ulcerative colitis
- Crohn disease
- Diverticulitis
- Large bowel obstruction
- Small bowel obstruction
- Peptic ulcer disease
- Acute pancreatitis
- Gastroenteritis
- Nephrolithiasis
- Pyelonephritis
- Choledocholithiasis
- Intraabdominal abscess
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:03/15/2021
Last Updated:10/31/2022
Last Updated:10/31/2022