This protocol applies to patients with ischemic colitis whose condition has not improved after an adequate initial course of careful supportive care and where the clinical course is expected to be more severe or protracted, necessitating an escalated approach.
The preceding management included intravenous fluid resuscitation, bowel rest (with nasogastric tube where ileus was present), intravenous antibiotics (anaerobic cover combined with a third-generation cephalosporin or fluoroquinolone, reviewed at 72 hours), and prophylactic low molecular weight heparin. The trigger for escalation is failure to achieve clinical improvement within 2–3 days, with particular attention to the antibiotic response review at 72 hours.
DOI: 10.1136/flgastro-2019-101204
In more severe cases where bowel rest is indicated and the course expected to be protracted, parenteral nutrition is indicated.
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