[Colonic ischaemia - a condition with an atypical clinical presentation; timely recognition and treatment improve...

The incidence of colonic ischaemia has risen in recent decades because of the ageing population. Patients with colonic ischaemia present with mild abdominal pain, rectal blood loss and/or diarrhoea. However, no pathognomonic signs have been described. Signs of peritonitis are often absent and serum lactate may be normal. This makes prompt recognition and diagnosis difficult, while early treatment with close monitoring is important to optimise prognosis. Computed tomography may have suggestive findings and exclude other causes of abdominal pain, but endoscopy remains the gold standard for confirming the diagnosis. Colonic ischaemia is mostly located in the left colon and has a relatively good prognosis. However, the presence of right-sided ischaemic colitis should alert physicians, because these patients have a worse prognosis, increased need for surgery and they also experience higher mortality rates.