The mainstay of treatment for ischemic colitis is medical therapy. Surgery is usually reserved for patients with either sepsis, persistent fever and leukocytosis, peritoneal irritation, protracted pain, diarrhea or bleeding, protein-losing colopathy for more than 14 days, free intra-abdominal air, or endoscopically-proved extensive gangrene. Laparotomy confirms the diagnosis and all affected bowel is resected. 20% of patients with acute ischemic colitis will require surgery with an associated mortality rate of up to 60%. Ileocolostomy is performed in patients with right-sided ischemic colitis with viable ileum and transverse colon.

• Surgery is not the first-line treatment option for patients with ischemic colitis. Surgery is usually reserved for patients with either:^[1][2]
  • Sepsis
  • Persistent fever and leukocytosis
  • Peritoneal irritation
  • Protracted pain
  • Diarrhea or bleeding
  • Protein-losing colopathy for more than 14 days
  • Free intra-abdominal air
  • Endoscopically-proven extensive gangrene

• Surgery for ischemic colitis is as follows:^[1][2][3]
  • 20% of patients with acute ischemic colitis will require surgery which has an associated mortality rate of up to 60%.
  • Laparotomy confirms the diagnosis and all affected bowel is resected.
  • Extent of resection should be guided by the distribution of disease seen on preoperative studies
  • Resected segment should be examined in the operating room for mucosal injury.

• Ileocolostomy is performed in patients with right-sided ischemic colitis with viable ileum and transverse colon.