Guideline sources The following summarized guidelines for the evaluation and management of colon ischemia are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG 2015). 1 2 2 3 4 Definition Colon ischemia is an injury to the colon due to reduced blood flow characterized by bloody bowel movements, abdominal pain, and leukocytosis. 2 Epidemiology Colon ischemia is caused by an acute compromise in intestinal (mainly splenic flexure and sigmoid colon) blood flow ( due to superior mesenteric artery, inferior mesenteric artery, and collateral blood supply). 3 Disease course The transient hypoperfusion of a part of the colon (mainly splenic flexure and sigmoid colon) results in colon ischemia, which causes clinical manifestations of acute onset of crampy abdominal pain, and bloody bowel movements. Severe ischemic may lead to peritonitis and sepsis. 2 Prognosis and risk of recurrence https://web.pathway.md/diseases/recGObhgFsL6vJUJo 1/3 6/23/23, 3:25 AM Colon ischemia Pathway The in-hospital mortality in patients with acute mesenteric ischemic undergoing intestinal resection due to necrosis is high at 56.7%. 4 Guidelines 1. Screening and diagnosis Clinical presentation: Assess for colon ischemia 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. B Assess for non-isolated right colon ischemia in patients with hematochezia. B 2. Diagnostic investigations Diagnostic imaging: obtain CT with intravenous and oral contrast as the initial imaging modality for patients with suspected colon ischemia. B Colonoscopy: obtain early colonoscopy (within 48 hours of presentation) in patients with suspected colon ischemia in order to confirm the diagnosis. B 3. Medical management General principles: recognize that most cases of colon ischemia resolve spontaneously and do not require specific therapy. B Antibiotic therapy: consider antimicrobial therapy for patients with moderate or severe disease. B 4. Surgical interventions Indications for surgery: Perform surgical intervention: in the presence of colon ischemia accompanied by hypotension, tachycardia, and abdominal pain without rectal bleeding for isolated right sided colon ischemia and pan-colonic colonic ischemia in the presence of large bowel gangrene. B References 1. Brandt LJ, Feuerstadt P, Longstreth GF et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia CI . Am J Gastroenterol. 2015 https://web.pathway.md/diseases/recGObhgFsL6vJUJo 2/3 6/23/23, 3:25 AM Colon ischemia Pathway Jan;110 1 18 44. Open 2. James F FitzGerald, Luis O Hernandez Iii. Ischemic colitis. 2015 Jun;28 2 93 8.2015 Jun;28 2 93 8. Open 3. ngeliki Theodoropoulou and Ioannis E outroubakis. Ischemic colitis: Clinical practice in diagnosis and treatment. World J Gastroenterol. 2008 Dec 28; 14 48 7302 7308. Open 4. Haluk Recai Unalp, Kemal Atahan, Erdinc Kamer et al. Prognostic factors for hospital mortality in patients with acute mesenteric ischemia who undergo intestinal resection due to necrosis]. 2010 Jan;16 1 63 70.2010 Jan;16 1 63 70. Open 5. James F. FitzGerald, Luis O. Hernandez III. Ischemic Colitis. Clin Colon Rectal Surg. 2015 Jun; 28 2 93 98. Open 6. Haluk Recai Unalp, Kemal Atahan, Erdin Kamer et al. Prognostic factors for hospital mortality in patients with acute mesenteric ischemia who undergo intestinal resection due to necrosis]. Ulus Travma Acil Cerrahi Derg. 2010 Jan;16 1 63 70. Open https://web.pathway.md/diseases/recGObhgFsL6vJUJo 3/3