A 75-year-old woman develops sudden onset cramping abdominal pain and bloody diarrhea 3 days after elective abdominal aortic aneurysm repair. She had intraoperative hypotension requiring vasopressors. CT shows segmental thickening of the splenic flexure with 'thumbprinting'. What is the most likely diagnosis and the initial management?

• A Ischemic colitis: supportive care with bowel rest and antibiotics ✓
• B Pseudomembranous colitis: oral vancomycin
• C Acute mesenteric ischemia: emergent laparotomy
• D Diverticulitis: intravenous antibiotics

Explanation

Ischemic colitis typically presents with post-operative hypotension or vascular surgery. The splenic flexure is a watershed area (Griffiths' point) most vulnerable to ischemia. CT findings of thumbprinting and segmental thickening are characteristic. Most cases are managed conservatively with bowel rest, fluids, and broad-spectrum antibiotics. Surgery is reserved for peritonitis or gangrene.

Reference: Sabiston Textbook of Surgery, 21st ed.

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