From the Guidelines
Initial laboratory tests for suspected ischemic colitis should include a complete blood count, comprehensive metabolic panel, lactate level, coagulation studies, and stool studies for infectious causes, as these tests can help identify leukocytosis, electrolyte abnormalities, tissue hypoperfusion, and other potential causes of ischemic colitis 1. The complete blood count can help assess for leukocytosis, which is present in more than 90% of patients with acute mesenteric ischemia 1.
- The comprehensive metabolic panel can evaluate electrolyte abnormalities and renal function, which can be affected in patients with ischemic colitis.
- The lactate level can help check for tissue hypoperfusion, which is a key feature of ischemic colitis, and elevated serum lactate levels > 2 mmol/l are associated with irreversible intestinal ischemia 1.
- Coagulation studies should also be performed, as patients with ischemic colitis may have coagulopathy.
- Stool studies for infectious causes can help rule out other potential causes of diarrhea and abdominal pain. Management of ischemic colitis begins with supportive care, including:
- Intravenous fluid resuscitation with crystalloids, such as normal saline, to correct hypovolemia and maintain perfusion of the bowel.
- Bowel rest, with nothing given by mouth, to reduce the metabolic demands of the bowel.
- Pain control with opioid analgesics as needed.
- Broad-spectrum antibiotics, such as a combination of metronidazole and ciprofloxacin, or piperacillin-tazobactam, should be initiated, especially if there are signs of peritonitis, sepsis, or pneumatosis intestinalis. It is essential to correct underlying causes, including discontinuation of vasoconstrictive medications and optimization of cardiac output. Patients require close monitoring with serial abdominal examinations and vital signs, and surgical consultation should be obtained early, as surgical intervention may be necessary for patients with peritoneal signs, gangrene, perforation, or clinical deterioration despite medical management 1.
From the Research
Initial Laboratory Tests for Ischemic Colitis
The initial laboratory tests for a patient suspected of having ischemic colitis are not specifically outlined in the provided studies, but the following can be considered based on the clinical presentation:
- Complete Blood Count (CBC) to evaluate for signs of infection or inflammation
- Electrolyte panel to assess for any imbalances
- Blood urea nitrogen (BUN) and creatinine to evaluate renal function
- Liver function tests (LFTs) to assess for any liver dysfunction
- Coagulation studies to evaluate for any coagulopathy
Management of Ischemic Colitis
The management of ischemic colitis involves:
- Supportive care with intravenous fluids to optimize hemodynamic status 2
- Bowel rest to reduce the metabolic demand of the bowel
- Empiric antibiotics to prevent or treat any bacterial overgrowth or infection 2
- Avoidance of vasoconstrictive drugs to prevent further reduction in blood flow to the bowel 2
- Surgical intervention may be necessary in cases of perforation, peritonitis, or persistent bleeding 2, 3, 4
Diagnostic Approach
The diagnostic approach for ischemic colitis involves:
- Clinical suspicion based on symptoms such as abdominal pain, diarrhea, and mild lower gastrointestinal bleeding 3, 4
- Radiographic images such as computed tomography (CT) or magnetic resonance imaging (MRI) may suggest the diagnosis, but are not definitive 3
- Colonoscopy with histological analysis of biopsies is the gold standard for diagnosis 2, 3, 4