A 68-year-old woman with atrial fibrillation on warfarin presents with acute onset of severe abdominal pain followed by bloody diarrhea. CT shows segmental thickening of the splenic flexure with pericolic fat stranding. What is the most likely diagnosis?
- A Acute mesenteric ischemia of the superior mesenteric artery
- B Ischemic colitis ✓
- C Pseudomembranous colitis
- D Diverticulitis
Correct answer: B. Ischemic colitis
Explanation
Ischemic colitis commonly affects watershed areas such as the splenic flexure (Griffiths point). It presents with acute abdominal pain followed by bloody diarrhea in an elderly patient with risk factors for low flow (atrial fibrillation). SMA ischemia typically causes midgut pain out of proportion to examination. Pseudomembranous colitis follows antibiotic use. Diverticulitis usually affects the sigmoid colon with left lower quadrant pain.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.