What initial management strategies should be implemented for a patient diagnosed with ischaemic colitis?

Initial management of ischaemic colitis primarily involves supportive care focused on stabilising the patient and preventing progression of bowel injury. This includes prompt assessment of the patient’s clinical status, with attention to hydration and correction of any underlying precipitating factors such as hypotension or cardiac insufficiency. Intravenous fluid resuscitation is essential to restore adequate perfusion and prevent further ischaemia. Bowel rest is recommended, typically by withholding oral intake initially to reduce colonic workload and allow mucosal healing.

Close monitoring for signs of clinical deterioration, such as worsening abdominal pain, peritonitis, or systemic sepsis, is critical. In uncomplicated cases, conservative management with supportive care and observation is often sufficient. Antibiotics may be considered if there is suspicion of bacterial translocation or secondary infection, although routine use is not universally mandated and should be guided by clinical judgment.

Patients with signs of complicated ischaemic colitis, including perforation, peritonitis, or persistent severe symptoms, require urgent surgical evaluation. Imaging, preferably contrast-enhanced CT scanning, is important to confirm diagnosis, assess the extent of ischaemia, and identify complications.

In summary, initial management strategies for ischaemic colitis include supportive care with intravenous fluids, bowel rest, careful clinical monitoring, selective use of antibiotics, and timely imaging to guide further intervention. Surgical referral is indicated for complicated cases or failure to improve with conservative measures ¹ (Hung et al., 2021).