A 76-year-old woman presents to the emergency department with sudden-onset crampy left lower quadrant abdominal pain followed several hours later by bloody diarrhea. Her medical history includes hypertension, coronary artery disease, and peripheral arterial disease. Medications include aspirin, lisinopril, and atorvastatin. Temperature is 37.1°C (98.8°F), blood pressure is 110/68 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination reveals mild left lower quadrant tenderness to palpation without peritoneal signs. Laboratory studies demonstrate mild leukocytosis.
Which of the following is the most likely diagnosis?
The correct answer is:
D: Ischemic colitis.
This patient has classic ischemic colitis: an older adult with vascular disease who develops abdominal pain followed by hematochezia. Unlike acute mesenteric ischemia, symptoms are generally less dramatic and examination findings are more proportional to the degree of discomfort.
Answer choice A: Acute mesenteric ischemia, is incorrect.
Mesenteric ischemia typically presents with severe pain out of proportion to examination findings and often without early bloody diarrhea.
Answer choice B: Crohn disease, is incorrect.
Crohn disease usually presents as a chronic inflammatory condition rather than an acute vascular event.
Answer choice C: Infectious gastroenteritis, is incorrect.
Infectious diarrhea can cause abdominal pain and diarrhea but is less likely to occur in this classic vascular-risk patient.
Answer choice E: Ulcerative colitis, is incorrect.
Ulcerative colitis generally presents in younger patients with a chronic history of symptoms such as abdominal cramping and diarrhea that may be mixed with blood or mucus.
Key Learning Point
Ischemic colitis classically presents in older patients with vascular risk factors who develop abdominal pain followed by hematochezia.
