Ischemic colitis medical therapy
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Ischemic colitis is usually treated with supportive care. Treatment is determined by its severity and include intravenous fluids, bowel rest, nasogastric tube, and total parenteral nutrition. Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression. There is no evidence about the role of anticoagulation or antiplatelet therapy. Steroids have not been shown to improve outcomes.
- Treatment is determined by its severity
- Patients with colonic dilatation are managed with insertion of a rectal tube or endoscopic decompression.
- There is no evidence about the role of anticoagulation or antiplatelet therapy.
- Steroids have not been shown to improve outcomes.
- Fluid resuscitation with:
Optimize Cardiac Output
- If possible, cardiac function and oxygenation should be optimized to improve oxygen delivery to the ischemic bowel.
- Antibiotic use in animal studies has demonstrated reduced duration and severity of ischemic colitis, and prevention of bacterial translocation through damaged mucosa.
- The role of antibiotic therapy in humans requires further research.
Algorithm of management of ischemic colitis
- The following algorithm represents the management of ischemic colitis.
|Abdominal pain, diarrhea, lower GI bleeding|
|Diagnosis by CT scan or colonoscopy|
|Stable or improving||Peritonitis signs or gangrenous bowel||Continuation of symptoms|
|Repeat colonoscopy after 2 weeks||Emergency laparatomy||Resection of diseased bowel|
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- Nikolic, Amanda L.; Keck, James O. (2017). "Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management". ANZ Journal of Surgery. doi:10.1111/ans.14237. ISSN 1445-1433.