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March 16, 1979

Roentgenographic Manifestations of Ischemic Colitis

Author Affiliations

From the Department of Radiology, Northwestern University Medical School, Chicago.

JAMA. 1979;241(11):1171-1173. doi:10.1001/jama.1979.03290370069037

A FREQUENTLY encountered diagnostic problem in older persons is acute abdominal pain accompanied by bloody diarrhea, invoking the differential diagnosis of diverticulitis, inflammatory bowel disease, infectious colitis, carcinoma of the colon, and ischemic colitis.1,2 The roentgenographic manifestations of ischemic colitis, namely, "thumbprinting," bowel-wall edema, ulcerations, intramural dissection of barium, and stricture, often resemble those of these other disease processes, and recognition may be difficult.3,4

Acute vascular insufficiency of the colon is a disease complex that presents as a spectrum ranging in severity from gangrenous infarction causing peritonitis and shock to a trivial episode of abdominal pain and diarrhea that a patient may recall only in retrospect.5,6 Where in this continuum an individual patient may fall depends on the duration and extent of the ischemia, the efficiency of collateral circulation, and the extent of bacterial invasion.7,8

Gangrenous Colitis  The catastrophic expression of colonic ischemia, gangrenous colitis, is