EP-408 Colonic mucosal dehiscence in a patient with ischemic colitis- A case report

Abstract

Abstract Introduction Ischemic colitis (IC) is the condition that results when blood flow to the colon is reduced to a level insufficient to maintain cellular metabolic function. Case summary A 36 year old female; diabetic, hypertensive, with history of CVA and IHD, presented in ER with complaints of sudden onset, severe, colicky abdominal pain. Examination revealed a mildly tense, tender abdomen at left iliac fossa with a palpable ill-defined mass. Her TLC was 31.6/L and hemoglobin 9.3 g/dL. Serum amylase, lipase and lactate levels were normal. CECT abd/ pelvis showed thickened, edematous sigmoid and descending colon, with extensive mesenteric haze and stranding. Colonoscopy showed an illdefined, obstructing growth in rectosigmoid region at 25 cm from anal verge. There were multiple ischemic patches and underlying erythema and ulceration with bleed to touch mucosa at few sites. Scope could not be passed further. Biopsy showed active non-specific colitis with no evidence of malignancy. Patient improved on conservative management and was discharged. Patient presented in ER 2 weeks later with a long tubular structure that was expelled per-rectum. The histopathology of this structure revealed intestinal tissue with marked autolytic and ischemic changes. Patient again presented in ER with abdominal pain and vomiting with increased TLC. A diagnosis of severe ischemic colitis (ACG guidelines 2005)presenting as rectosigmoid mass was made and left hemi-colectomy was planned. Discussion This is a rare case of colonic mucosal shedding in ischemic colitis only described once in literature. Conclusion This case demonstrates the unusual way in which colonic ischemia can present.