Diagnosis

Ischemic colitis can often be confused with other disorders because their symptoms overlap, especially inflammatory bowel disease (IBD). Based on your signs and symptoms, your doctor may recommend these imaging tests:

  • Ultrasound and abdominal CT scans, to provide images of your colon that can be helpful in ruling out other disorders, such as IBD.
  • Stool analysis, to rule out infection as a cause of your symptoms.
  • CT or MRI angiography, to provide detailed images of blood flow in your small intestine and to look for blocked arteries. This test is usually used only if ischemia is suspected in your small bowel as well as in your colon.
  • Colonoscopy. This test, which provides detailed images of your colon, can be helpful in diagnosing ischemic colitis. Colonoscopy can also be used to check for cancer, and to see how well a treatment worked.

Treatment

Treatment for ischemic colitis depends on the severity of your condition.

Signs and symptoms often diminish in two to three days in mild cases. But your doctor may recommend:

  • Antibiotics, to prevent infections
  • Intravenous fluids, if you are dehydrated
  • Treatment for any underlying medical condition, such as congestive heart failure or an irregular heartbeat
  • Avoiding medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs

Your doctor will schedule follow-up colonoscopies to monitor healing and look for complications.

Surgery

While most cases resolve on their own, if your symptoms are severe, or your colon has been damaged, you may need surgery to:

  • Remove dead tissue
  • Repair a hole in your colon
  • Bypass a blockage in an intestinal artery
  • Remove part of the colon that has narrowed because of scarring and is causing a blockage

The likelihood of surgery may be higher if you have an underlying condition, such as heart disease or low blood pressure.

Preparing for your appointment

Go to the emergency room if you have severe abdominal pain that makes you so uncomfortable that you can't sit still. You may be referred for immediate surgery to diagnose and treat your condition.

If your signs and symptoms are moderate and occasional, call your doctor for an appointment. After an initial evaluation, you may be referred to a doctor who specializes in digestive disorders (gastroenterologist) or blood vessel disorders (vascular surgeon).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions, such as not eating after midnight on the night before your appointment.
  • Write down your symptoms, including when they started and how they may have changed or worsened over time.
  • Write down your key medical information, including other conditions with which you've been diagnosed.
  • Make a list of all medications, vitamins and supplements that you're taking.
  • Write down questions to ask your doctor.

Questions to ask your doctor

  • What is the most likely cause of my condition?
  • What kinds of tests do I need?
  • I have other health problems. How can I best manage these conditions together?
  • If I need surgery, what will my recovery be like?
  • How will my diet and lifestyle change after I have surgery?
  • What follow-up care will I need?

What to expect from your doctor

Your doctor is likely to ask you questions about your symptoms, such as:

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Where do you feel your symptoms the most?
  • Does anything seem to make your symptoms better?
  • What, if anything, seems to worsen your symptoms?
Oct. 13, 2015
References
  1. Brandt LJ, et al. ACG clinical guideline: Epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). American Journal of Gastroenterology. 2015;110:18.
  2. Grubel P, et al. Colonic ischemia. http://www.uptodate.com/home. Accessed July 27, 2015.
  3. Navid K, et al. Ischemic colitis. Hospital Medicine Clinics. 2015;4:216.
  4. Yaddav S, et al. A population-based study of incidence, risk factors, clinical spectrum, and outcomes of ischemic colitis. Clinical Gastroenterology and Hepatology. 2015;13:731.
  5. Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. July 29, 2015.