Colitis in the Adolescent Population: Management in the Emergency Department

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Publication Date: October 2025 (Volume 22, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 10/01/2028.

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Abstract

Colitis presents as an inflammatory diarrhea that is often accompanied by abdominal pain. The differential diagnosis of colitis is broad and depends on the presenting symptoms and age of the patient. Although infectious colitis in an immunocompetent child is often self-limited, complications of colitis can be serious, and early recognition can expedite critical medical interventions and surgical consultation. This issue provides an evidence-based approach to the evaluation and management of colitis and associated acute complications in adolescent patients in the emergency department.

Case Presentations

A 16-year-old previously healthy boy presents with complaints of moderate to severe abdominal pain and loose, bloody stools...

• The boy says his symptoms began approximately 2 weeks prior to presentation and have worsened over the past 2 to 3 days. He states that he is passing several loose, bloody stools per day and that bowel movements are very painful. Over the past 24 hours he has developed tactile fever and chills. He denies vomiting. He reports that he has had a loss of appetite and an unintentional 10-pound weight loss over the past “couple of months.”
• On examination, he is febrile, mildly tachycardic, and appears ill. His vital signs are: temperature, 38.3°C; heart rate, 118 beats/min; blood pressure, 125/70 mm Hg; respiratory rate, 16 breaths/min; and oxygen saturation, 98% on room air. He is diffusely tender to palpation, especially in the left lower quadrant; he guards his abdomen.
• What additional history can help in determining the cause of this patient’s symptoms?

A 13-year-old boy with autism and a history of chronic constipation is brought in by his mother with concern for acute-on-chronic abdominal pain...

• The boy’s mother states that it is not unusual for her son to complain of abdominal pain, but that it appears that the pain has been more severe over the past 2 days, and he has been unable to attend school. She reports that he normally has hard and infrequent stools, but that for the past week, he has been having loose and watery stools with occasional soiling of his underwear. She denies recent fever or vomiting. She has noted decreased appetite. There are no known sick contacts.
• On examination, the child is afebrile and nontoxic but appears uncomfortable. His vital signs are: temperature, 36.7°C; heart rate, 95 beats/min; blood pressure, 130/75 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 99% on room air. His abdomen is somewhat firm, mildly distended, and diffusely tender to touch.
• What conditions are on your differential for this patient?

A 17-year-old girl is brought in by her mother for concern for diarrhea and worsening abdominal pain...

• The patient has a history of a cholecystectomy 4 months prior to presentation but has no other significant past medical history. The teenager reports that she has had almost daily lower abdominal pain for the past 4 weeks. She also reports up to 10 loose stools per day that contain bright red blood.
• On examination, she is somewhat ill but nontoxic-appearing. She is afebrile and has normal vital signs. Her abdomen is soft and nondistended, tender to bilateral lower quadrants, with positive bowel sounds and no rebound or guarding.
• What workup is warranted for this patient?

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