What is the next step in managing a patient with abdominal pain, who is hemodynamically stable, and has imaging findings of increased thickness of the sigmoid colon and thumbprint sign due to edema, suggestive of ischemic colitis?

From the Research

The next step in managing this patient with abdominal pain, stable vital signs, and imaging showing sigmoid thickening with thumbprint sign due to edema would be option A, Colonoscopy. This recommendation is based on the most recent and highest quality study available, which suggests that colonoscopy is the gold standard for diagnosing ischemic colitis 1. The clinical presentation of abdominal pain, stable vital signs, and imaging findings of sigmoid thickening with thumbprint sign due to edema is highly suggestive of ischemic colitis. Key points to consider in the management of this patient include:

• The importance of establishing a definitive diagnosis through direct visualization and tissue sampling
• The need to assess the extent and severity of ischemic injury to guide treatment decisions
• The potential risks and benefits of different diagnostic and therapeutic approaches, including colonoscopy, CTA, and surgical options
• The role of supportive care, including intravenous fluids, optimization of hemodynamic status, and empiric antibiotics, in managing patients with ischemic colitis 2 While CTA may provide valuable information about the vascular etiology and extent of compromise, colonoscopy is the preferred next step due to its ability to provide a definitive diagnosis and guide treatment decisions. Surgical options like diagnostic laparoscopy or exploratory laparotomy would be premature without first establishing the diagnosis and extent of compromise through colonoscopy. It is also important to note that the diagnosis of ischemic colitis is typically made by medical history, examination, and endoscopy, which have become the diagnostic procedure of choice 1. In addition, the incidence of colonic ischemia is difficult to ascertain, and a high index of suspicion and prompt management are essential for optimum outcomes in patients with colonic ischemia 1. Overall, the management of this patient should prioritize establishing a definitive diagnosis through colonoscopy, assessing the extent and severity of ischemic injury, and guiding treatment decisions based on the results of these evaluations.