Ischemic Colitis - Signs and Symptoms

Signs and Symptoms

One of the oft-quoted, key traits of ischemic colitis is "pain out of proportion to physical findings", specifically excruciating abdominal pain despite limited focal tenderness.

Three progressive phases of ischemic colitis have been described:

• A hyperactive phase occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.

• A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.

• Finally, a shock phase can develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.

Symptoms of ischemic colitis vary depending on the severity of the ischemia. The most common early signs of ischemic colitis include abdominal pain(often left-sided), with mild to moderate amounts of rectal bleeding. The sensitivity of findings among 73 patients were:

• abdominal pain (78%)
• lower digestive bleeding (62%)
• diarrhea (38%)
• Fever higher than 38°C (34%) (38°C equals approximately 100.4°F)

Physical examination

• abdominal pain (77%)
• abdominal tenderness (21%)