ROSH Gastrointestinal Practice Exam

What is the most likely diagnosis for an 82-year-old man with severe left-sided abdominal pain and bloody bowel movements after a myocardial infarction?

1. Cholecystitis

2. Diverticulitis

3. Intestinal angina

4. Ischemic colitis

The correct answer is: Ischemic colitis

The scenario describes an elderly man with severe left-sided abdominal pain and bloody bowel movements following a myocardial infarction. This clinical presentation is strongly suggestive of ischemic colitis. Ischemic colitis occurs when blood flow to the colon is reduced, which can happen as a result of vascular compromise—often related to cardiovascular conditions like myocardial infarction. In elderly patients, this compromised blood flow can lead to bowel ischemia, causing abdominal pain and potentially resulting in bloody stools due to the damage inflicted on the intestinal lining. The left-sided abdominal pain aligns with ischemic colitis, especially if the ischemia affects the splenic flexure or descending colon areas. The bloody bowel movements further support this diagnosis, as ischemic colitis can lead to mucosal injury and subsequent bleeding. Other conditions listed, while they can cause abdominal pain or gastrointestinal symptoms, do not fit the clinical picture as closely. Cholecystitis typically presents with right upper quadrant pain rather than left-sided pain, and diverticulitis may cause localized pain, but is less likely to present with bloody stools after a recent myocardial infarction compared to ischemic colitis. Intestinal angina refers more to pain caused by ischemia during exertion rather than ongoing pain with