1530 Colo Low Flow: A Case of Exercise-Induced Colon Ischemia

Abstract

INTRODUCTION: Colon ischemia is the most common type of mesenteric ischemia and is responsible for 15% of hospitalizations for acute lower gastrointestinal bleeding.1 While it predominately affects the elderly, colonic ischemia can occur in younger individuals during periods of intense exercise, typically long-distance or marathon runners.2,3 CASE DESCRIPTION/METHODS: A 28 year-old male with a past medical history of type 2 diabetes mellitus and obesity presented to the hospital with two days of generalized abdominal pain associated with fevers, fatigue, and general malaise. The patient denied any diarrhea, blood in his stool, or vomiting. The patient did report an intentional 60 lb weight loss in the last 6 weeks through a diet and exercise regimen including up to 60 minutes of exercise per day. Physical examination demonstrated mild right sided abdominal tenderness but was otherwise unremarkable. Initial imaging with CT abdomen showed thickening and inflammation in the cecum and terminal ileum (Figure 1). Laboratory studies were normal apart from mild elevations of lactic acid 1.0, CRP 14.4, and ESR 31. Subsequently, a colonoscopy was performed which showed mild to moderate colon ischemia at the ileocecal valve and in the proximal right colon (Figures 2a and b). Sources of potential ischemia were further investigated with a CT angiography of the abdomen and echocardiography, both of which were normal. Given that no source of ischemia could be identified, the patient was diagnosed with colon ischemia secondary to exercise and managed with supportive care and close follow-up. DISCUSSION: Our case highlights an episode of nonocclusive colon ischemia triggered by shunting of blood away from the colon during periods of exercise. Importantly, our patient's presentation was non-specific and not characteristic for colon ischemia, which is classically a disease of elderly patients with risk factors for atherosclerotic disease; furthermore, when colon ischemia is induced by physical activity, most case reports have shown it is due to prolong intense exercise in long-distance and marathon runners.2,3 The occurrence of colon ischemia with only a moderate level of activity may be a reflection of the significant increase in our patient's activity from baseline without complete physiological adaptation. As such, it is important that clinicians are cognizant of the possibility for colon ischemia in any patient with regular exercise patterns, in particular if this represents a recent behavior change.