A 74-year-old man with atrial fibrillation develops sudden left-sided abdominal pain and bloody diarrhea. CT shows segmental wall thickening with thumbprinting at the splenic flexure. He is afebrile, hemodynamically stable and has no peritoneal signs. What is the most appropriate management?
- A Immediate subtotal colectomy
- B Urgent colonoscopy with balloon dilation of the narrowed segment
- C Conservative management with bowel rest, fluids and broad-spectrum antibiotics ✓
- D Systemic anticoagulation identical to mesenteric arterial embolism protocols
Correct answer: C. Conservative management with bowel rest, fluids and broad-spectrum antibiotics
Explanation
Ischemic colitis affects watershed zones such as the splenic flexure and typically presents with left-sided pain and bloody diarrhea. In the absence of gangrene, perforation or fulminant pancolitis, most cases resolve completely with conservative management over days to weeks. Surgery is indicated only for peritonitis, perforation or sepsis suggesting transmural infarction. Full-dose anticoagulation is not the mainstay here, unlike acute superior mesenteric artery embolism, because the insult is usually a transient low-flow episode.
Reference: Schwartz's Principles of Surgery, 11th ed.
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