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Tests and diagnosis
By Mayo Clinic staffDiagnosing the cause of your symptoms may include a:
- Physical exam and medical history. Your doctor begins by taking a medical history and conducting a thorough physical examination. During the exam, he or she will check your abdomen for areas of tenderness.
- Colonoscopy. A colonoscopy is considered the definitive test for diagnosing ischemic colitis. In this procedure, a flexible lighted tube is inserted into your rectum and guided into the colon. A tiny camera at the tip of the scope sends images of your colon to a video screen. Your doctor can then view the interior lining of your colon and detect any inflammatory tissue and ulcers.
- Biopsy. Sometimes, as part of a colonoscopy, your doctor may remove a small tissue sample (biopsy) from your colon for laboratory analysis. In ischemic colitis, swelling and bleeding may be present under the colon's lining (mucosal layers), and can be detected in the laboratory.
A colonoscopy can rule out other causes of inflammation in your colon, including certain infections, inflammatory bowel disease, inflammation of the walls of the intestines (diverticulitis) and colon cancer. If the inflammation is severe, your doctor may not be able to see your entire colon well or obtain adequate biopsies.
If this happens, you may need to have a repeat colonoscopy once the inflammation has subsided. This allows your doctor to be sure that nothing of concern is present, such as persistent inflammation, scarring or colon cancer.
Other diagnostic tests
Your doctor may also suggest these other procedures to make a diagnosis:
- X-rays of the abdomen and pelvis. These may be conducted in combination with a barium enema. In this process, a contrast material (liquid barium) is introduced into your colon through your rectum. Once your colon is coated with barium, a radiologist takes X-ray pictures of your intestines. These images, which can be viewed on a video monitor, can detect abnormalities within your colon and help distinguish ischemic colitis from other inflammatory conditions. Images that indicate ischemic colitis may show thickening (thumbprinting) of the wall of your colon.
- Abdominal arteriogram. This is an X-ray of the arteries in your abdomen. It can show narrowing or blockages in these vessels, which may indicate ischemic colitis. A contrast dye is injected into your arteries before the X-rays are taken to help produce clear images.
- Ultrasound. This imaging test uses sound waves to provide images of your colon. It can be helpful in ruling out other disorders, such as inflammatory bowel disease. For the procedure, a device called a transducer that emits sound waves is rolled over your abdomen. Information captured by the transducer is sent to a computer that produces the images.
- Abdominal computerized tomography (CT) scans. Doctors sometimes use these scans to rule out other conditions that can cause symptoms similar to ischemic colitis. This test uses sophisticated X-ray technology to produce detailed cross-sectional images of your colon. Your doctor may be able to detect thickening of the colon wall on the scans.
- Blood tests. People with ischemic colitis may have an elevated white blood cell count (WBC) that occurs when there's inflammation or the body is fighting an infection. If your doctor suspects you have a blood-clotting problem, you may be referred to a blood specialist (hematologist) for more-specific blood tests.
- Stool sample. Analysis of a sample of your stool in the laboratory may reveal bacteria and other infectious microorganisms associated or confused with ischemic colitis.
- McQuaid KR. Gastrointestinal disorders. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. 49th ed. New York, N.Y: McGraw-Hill; 2010. http://www.accessmedicine.com/content.aspx?aID=6395. Accessed May 27, 2010.
- Stoffel EM, et al. Mesenteric ischemia. In: Greenberger NJ, et al. Current Diagnosis and Treatment: Gastroenterology, Hepatology, & Endoscopy. New York, N.Y: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=6200589. Accessed May 27, 2010.
- Sun MY, et al. Ischemic colitis. Clinics in Colon and Rectal Surgery. 2007;20:5.
- Koutroubakis IE. Ischemic colitis: Clinical practice in diagnosis and treatment. World Journal of Gastroenterology. 2008;14:7302.
- Sotiriadis J, et al. Ischemic colitis has a worse prognosis when isolated to the right side of the colon. American Journal of Gastroenterology. 2007;102:2247.
- Grubel P, et al. Colonic ischemic. http://www.uptodate.com/home/index.html. Accessed May 28, 2010.
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