Ischemic colitis

Case contributed by Dr Vikas Shah

Presentation

1 day history of abdominal pain and diarrhea tinged with blood.

Patient Data

Age: 80 years
Gender: Female
CT

Circumferential low density thickening of the large bowel from the mid transverse round to the mid descending colon. Uncomplicated sigmoid diverticulosis. Normal enhancement of the heavily calcified arteries.

Case Discussion

Ischemic colitis typically occurs in the watershed or borderzone territory of the colon, between the segments supplied by the superior and inferior mesenteric arteries. A period of hypotension leads to hypoperfusion within the watershed territory. With close monitoring, a conservative path may be followed but resection may be necessary if there is a deterioration in clinical status.

The particular segment of colon involved in this case makes other causes of colitis such as infection or inflammatory bowel disease less likely.

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