Case 120: Ischemic Colitis Limited to the Cecum

Abstract

A 75-year-old woman presented to the emergency department and reported new onset of diffuse abdominal cramps, nausea, fever, and chills. The patient had an extensive history of cardiac procedures, including placement of an aortic valve prosthesis and cardiac catheterization performed 10 days prior to the current admission. Her medical history was also notable for long-standing celiac sprue and acute appendicitis at age 13 that was treated with appendectomy. The patient denied recent foreign travel. Physical examination revealed mild right lower quadrant tenderness without signs of peritonitis and a fever of 100.4°F (38.0°C). White blood cell count, including absolute neutrophil count, was normal. Computed tomographic (CT) examination of the abdomen and pelvis was performed with only intravenous contrast material (100 mL of iohexol, Omnipaque 300; Amersham Health, Princeton, NJ) on day 1 and with both oral (15 g of diatrizoate sodium in 24 oz of water; Hypaque Sodium, Amersham Health) and intravenous contrast material on day 2.