Introduction Ischemia of the colon secondary to atherosclerosis of SMA, systemic hypotension, or after aortic graft placement systemic hypotension can also cause ischemia of other GI organs including the liver Most commonly involves splenic flexure is the "watershed" area of perfusion in the bowel between the IMA and SMA rectosigmoid junction also a watershed Elderly patients most commonly affected result of systemic vascular disease/atherosclerosis also seen following sacroiliac surgery Presentation Symptoms weight loss mild to moderate abdominal pain in comparison to severe pain associated with acute mesenteric artery ischemia can be localized to the LUQ hematochezia typically self limited that follows abdominal pain by 12-24 hours Evaluation Labs can show extreme leukocytosis with left shift Barium enema shows "thumb printing" of affected colon Prognosis, Prevention, and Complications Stricture/obstruction in region infarcted bowel