An Atypical Presentation of Ischemic Colitis

Abstract

Purpose: A 58-year-old man was referred to our department for a screening colonoscopy after a recent admission for sepsis due to Streptococcus bovis bacteremia. His past medical history is significant for hypertension, diabetes and coronary artery disease. No prior abdominal surgeries. The patient is a former smoker with a body mass index of 36 kg/m2 and has no family history of colon cancer. A CT abdomen and pelvis done prior to his referral showed a focal circumferential wall thickening in the cecum, which is extending into the proximal ascending colon and into the ileocecal valve. At colonoscopy, an ulcerated, necrotic near completely obstructing large mass was found in the cecum concerning for malignancy (Figure 1). However, the pathology was suggestive of ischemic colitis with no coexistent carcinoma. Repeat colonoscopy couple weeks later showed complete resolution of the previously noted mass in the cecum (Figure 2). This case illustrates a different endoscopic feature of ischemic colitis. Although the pre-test probability of cancer is high in this patient, he did have multiple risk factors for ischemic colitis including a recent admission with septic shock.Figure: No Caption available.Figure: No Caption available.