Related Experiment Video
Updated: Aug 23, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Colonic ischemia: an under-recognized cause of lower gastrointestinal bleeding
Brian S Ullery1, Andrew T Boyko, Gerald A Banet
1Division of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
Insights
Patients with colonic ischemia, often older, present with gastrointestinal bleeding and are misdiagnosed more frequently in the Emergency Department (ED) than those with mesenteric ischemia.
Area of Science:
- Gastroenterology
- Emergency Medicine
- Surgical Outcomes
Background:
- Intestinal ischemia is a critical condition with significant morbidity and mortality.
- Differentiating between mesenteric and colonic ischemia is crucial for appropriate management.
- Emergency Department (ED) diagnosis of intestinal ischemia can be challenging.
Purpose of the Study:
- To compare the signs, symptoms, clinical course, and outcomes of patients with mesenteric ischemia versus colonic ischemia.
- To identify key differences in presentation and diagnosis between the two types of intestinal ischemia.
- To improve the diagnostic accuracy of intestinal ischemia in the ED.
Main Methods:
- Retrospective review of 100 patient charts with ICD-9 codes for mesenteric or intestinal ischemia.
- Comparison of demographic data, presenting symptoms, and ED diagnostic accuracy between mesenteric and colonic ischemia groups.
- Analysis of clinical course and patient outcomes.
Main Results:
- Patients with colonic ischemia were older (77 vs. 61 years) and more likely to present with gastrointestinal (GI) bleeding (90% vs. 11%) compared to mesenteric ischemia.
- Abdominal pain was a less frequent primary complaint in colonic ischemia (10% vs. 89%).
- Colonic ischemia patients had significantly lower correct ED diagnosis rates (9% vs. 75%).
Conclusions:
- Colonic ischemia often presents with gross GI bleeding and is frequently misdiagnosed in the ED.
- Intestinal ischemia, particularly colonic, should be strongly considered in ED patients with GI bleeding and relevant risk factors.
- Timely diagnosis and treatment are essential for improving outcomes in patients with intestinal ischemia.
Abstract:
We described signs and symptoms of patients who present to an Emergency Department (ED) with intestinal ischemia and compare clinical course and outcomes of patients with mesenteric vs. colonic ischemia. We retrospectively reviewed charts of 100 patients discharged from our hospital with an ICD-9 code for mesenteric or intestinal ischemia. Compared to patients with mesenteric ischemia, those with colonic ischemia were older (61 vs. 77 years, respectively; p = 0.002), were more likely to present with gastrointestinal (GI) bleeding (11 vs. 90%, respectively; p < 0.001), but were less likely to report abdominal pain as their primary complaint (89% vs. 10%, respectively; p < 0.001) or to receive a correct ED diagnosis (75% vs. 9%, respectively; p < 0.001). Patients with colonic ischemia frequently presented with gross GI bleeding, and were often misdiagnosed in the ED. For timely treatment of a potentially serious condition, the diagnosis of intestinal ischemia should be considered in ED patients presenting with GI bleeding and appropriate risk factors.
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