Review Question - QID 101148

This patient's presentation is consistent with ischemic colitis secondary to an atherosclerotic process.

Ischemic colitis is caused by changes in systemic circulation, narrowing of blood vessels, or a blood clot that results in a loss of blood flow to the large intestine. Most commonly, ischemic colitis occurs at the splenic flexure, a "watershed" area supplied by both the superior and inferior mesenteric arteries. Patients often have a history of hyperlipidemia and cardiovascular disease, and may present with mesenteric angina with meals, secondary to athersclerotic lesions of superior mesenteric artery.

Gandhi et al. review the diagnosis and treatment of ischemic colitis. They report that ischemic colitis is the most common form of gastrointestinal ischemia, which typically presents with acute abdominal pain and bloody diarrhea.

Yasuhara clarifies the difference between mesenteric angina and ischemic colitis in which there are three major categories based on its clinical features: acute mesenteric ischemia (AMI), chronic mesenteric ischemia (intestinal angina), and colonic ischemia (ischemic colitis). See "Mesenteric Ischemia" topic for clarification.

Illustration A demonstrates ischemic colitis as confirmed by a barium study, which shows "thumb-printing" of the colonic mucosa secondary to edema.

Incorrect answers:
Answer 2: Peptic ulcer disease would likely show findings on an upper endoscopy (esophagogastroduodenoscopy).
Answer 3: Post-prandial pain and fear of eating in the setting of known atherosclerotic disease are more consistent with ischemic colitis than with Crohn's disease.
Answer 4: Amyloid deposition results in amyloidosis, which does not typically present with post-prandial pain.
Answer 5: Diverticulosis can present with painless bright red rectal bleeding (hematochezia), but is often asymptomatic.