[whipple23]

A 72-year-old man status post–coronary artery bypass graft (CABG) 5 years ago presents with hematochezia, abdominal pain, and fevers. Colonoscopy reveals patches of dusky-appearing mucosa at the splenic flexure without active bleeding. Which of the following is the most appropriate management of this patient?
A. Angiography with administration of intra-arterial papaverine
B. Emergent laparotomy with left hemicolectomy and transverse colostomy
C. Aortomesenteric bypass
D. Exploratory laparotomy with thrombectomy of the inferior mesenteric artery
E. Expectant management

 

[alsane_md]

I think it is B

 

[DAVE]

Ischemic bowel disease (Water shed are?)

I will go with (B)

 

[BritneySpears]

The answer is e. (Townsend ,pp1441-1443)

Ischemic colitis presents as hematochezia, fever, and abdominal pain.

Unlike acute mesenteric ischemia, which affects the small intestine and requires emergent intervention, ischemic colitis rarely requires surgical intervention unless full-thickness necrosis, perforation, or refractory bleeeding are present.

Expectant management with intravenous fluids, bowel rest, and supportive care is the treatment of choice.​

 

[abbas.rz]

The answer is e. (Townsend ,pp1441-1443)

Ischemic colitis presents as hematochezia, fever, and abdominal pain.

Unlike acute mesenteric ischemia, which affects the small intestine and requires emergent intervention, ischemic colitis rarely requires surgical intervention unless full-thickness necrosis, perforation, or refractory bleeeding are present.

Expectant management with intravenous fluids, bowel rest, and supportive care is the treatment of choice.​

Informative but very tough