When to suspect ischemic colitis - Why is this condition so often missed or misdiagnosed?

Ischemic colitis is one of the most often seen disorders of the large intes tine in the elderly. Common predisposing factors are atherosclerosis, shock , and congestive heart failure, but often, elderly patients have no obvious predisposing or precipitating factors. The typical clinical presentation i s acute sudden abdominal pain and distention with bloody diarrhea. Common e arly radiographic signs are bowel-wall thickening with thumbprinting, and l ater, ulceration and strictures may be found. Endoscopy is valuable in reve aling the sharp demarcation between viable and necrotic colonic mucosa that is a strong indicator of ischemia. Within 48 hours, most patients show fav orable response to conservative measures consisting of intravenous hydratio n, bowel rest, antibiotic therapy, and correction of precipitating processe s. Vasoconstricting drugs and corticosteroids are contraindicated. When sur gical intervention is indicated, it usually consists of resection of the is chemic segment and exteriorization of the remaining ends of the bowel.