What are the key clinical features that suggest ischaemic colitis in a patient presenting with abdominal pain?

Key clinical features suggesting ischaemic colitis in a patient presenting with abdominal pain include:

• Sudden onset of crampy, lower abdominal pain, often localized to the left side.
• Associated tenderness on abdominal examination, typically over the affected colon segment.
• Passage of bloody diarrhoea or rectal bleeding shortly after the onset of pain.
• Systemic signs may be mild or absent initially but can include low-grade fever.
• Risk factors such as advanced age, cardiovascular disease, or hypotensive episodes often coexist.

These features reflect transient or partial colonic ischaemia leading to mucosal injury and inflammation. The combination of abdominal pain followed by bloody diarrhoea is particularly suggestive. Early recognition is important to differentiate from other causes of acute abdomen and to guide appropriate management NICE NG147 Sreenarasimhaiah 2005Rania et al. 2014Xu et al. 2021.