A Rare Case of Acute Ischemic Colitis in a 33-Year-Old Female with No Known Risk Factors

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Purpose: Acute ischemic colitis (AIS) is a rare, rapid onset injury of the large intestine arising from decreased perfusion and as a result insufficient supply of metabolic demands. Loss of perfusion resulting in AIS could be due to occlusive, non-occlusive or spastic disease of the vessels. AIS occurs mostly in the elderly and usually has identifiable precipitating factors. AIS can be due to estrogen or oral contraceptive use, vascular disease, diabetes, coagulopathies, hypercoaguable states, cocaine use and long distance running. We present a case of AIS in a young female without any of these known risk factors. Case: A 33-year-old female was admitted with complaints of abdominal pain and 2 episodes of bloody diarrhea over 6 hours. The patient also reported one bout of non-bloody vomiting and had another episode of bloody diarrhea while waiting in the emergency room. The patient had a past history significant for irritable bowel syndrome diagnosed 5 years prior. She had no significant past surgical or family history. Patient worked at school, denied smoking, had 2-3 beers a month, denied substance abuse, had no recent travel and was divorced. She was sexually active with her boyfriend, not using oral contraceptive pills for contraception. Patient was hemodynamically stable on admission. On physical examination abdomen was soft, non-tender, non-distended and bowel sounds were heard throughout. Rectal exam yielded bright red blood on finger, normal sphincter tone and no external hemorrhoids were visualized. Laboratory evaluation revealed nothing abnormal and sigmoidoscopy and biopsy confirmed active colitis with ulcerations and changes consistent with ischemia. Urine toxicology was negative, patient had normal coagulation studies, no hypercoaguable state and denied herbal medication use. Diagnosis of AIS was made and patient was provided supportive care until symptoms subsided. Conclusion: AIS is usually seen in the elderly with multiple comorbidities including those on oral contraceptive pills, with vascular disease, diabetes, coagulopathies, cocaine use and long distance running. Diagnosis is made by history, laboratory results, and diagnostic imaging including colonoscopy. The majority of the cases occur in the elderly. Review of literature reveals that a case with a young female with no comorbidities and no other known risk factors or significant laboratory findings is very rare.