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Ischaemic Colitis — RACP Adult Medicine MCQ

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ModerateGastroenterologyIschaemic ColitisRACP Adult Medicine

A 78-year-old woman with peripheral vascular disease presents with sudden onset of left-sided abdominal pain and bloody diarrhoea. CT abdomen shows wall thickening of the descending colon at the splenic flexure. Colonoscopy shows segmental erythema with a sharp transition at the splenic flexure. What is the most likely diagnosis?

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Correct answer: C — Ischaemic colitis

Sudden bloody diarrhoea in an elderly patient with vascular risk factors and segmental colitis at the splenic flexure (a watershed zone between SMA and IMA territories) is classic for ischaemic colitis. Most cases resolve with supportive care. Gangrene or perforation requires surgical intervention.

Reference: eTG Gastrointestinal – 2024 – Ischaemic Colitis