Easy to think, difficult to treat: ischemic colitis

A 72-year-old man had a previous history of myocardial infarction and renal insufficiency with hemodialysis in relation to policystyc kidneys. He started with acute abdominal pain, diarrea and mild rectorragia without  fever or vomiting…

Physical examination showed a person with strong abdominal pain located on the left superior area without  peristaltic movement. A clinical diagnosis of ischemic colitis was established and a colonoscopy was indicated but only a 40 cm segment could be examined.

A laparotomy established the definitive diagnosis of ischemic colitis located on the splenic angle. The patient had a total clinical recovery.

COMMENT: Ischemic colitis is a difficult diagnosis for two reason: one because symptoms are common to other entities, and because is not always possible a surgical intervention due to the general situation of the patient. In this situation is very important to increase the “probability pre-test” using clinical signs and symptoms (classically abdominal pain, diarrea due to hypermotility and mild rectorragia) and radiological images with a characteristic loss of the “haustras” in the ischemic colonic segment.

The right colon, the splenic angle and the recto-sigma junction are the most common areas involved.