Ischemic Colitis Complicated by Consumptive Coagulopathy

Abstract

Colonic ischemia-induced reperfusion injury can lead to multisystem organ failure, regardless of ischemic colitis etiology. However, it rarely leads to consumptive coagulopathy. A review of the current literature shows that there have been limited reported cases of colonic ischemia-induced consumptive coagulopathy. Known etiologies of disseminated intravascular coagulopathy (DIC) include sepsis, malignancy, trauma, and intravascular hemolysis. Ischemic colitis is not a known cause of disseminated intravascular coagulopathy; however, we can relate it to the mechanism of sepsis-induced disseminated intravascular coagulopathy as sepsis is frequently complicated by disseminated intravascular coagulopathy. Disseminating intravascular coagulopathy is the activation of intravascular coagulation culminating in intravascular fibrin formation and deposition into the microvasculature. Secondary fibrinolysis accompanies coagulation activation. Intravascular deposition of fibrin in sepsis leads to a diffuse obstruction of the microvascular bed resulting in progressive organ dysfunction, such as in acute respiratory distress syndrome, acute kidney injury, hypotension, and shock liver. Both the coagulation activation and the consumption of coagulation inhibitors leading to anticoagulation pathways are activated in sepsis, leading to consumptive coagulopathy. Consumptive coagulopathy was an unexpected response to ischemic colitis. We present a case of a 71 year old Hispanic female with past medical history significant for hypertension presented to our facility with sudden onset diffuse abdominal pain and bright red blood per rectum. Work up revealed hematologic profile significant for DIC in addition to acute kidney injury and ischemic hepatitis, negative for schistocytes on peripheral blood smear. Colonoscopy revealed severe ischemic colitis with submucosal hemorrhage and necrosis involving descending colon. Biopsy from colonoscopy was consistent with observation, revealing acute colitis with focal ischemic changes, granulation tissue, and acute inflammatory exudate of descending colon. We believe that the intense inflammatory reaction of ischemic colitis led to this consumptive coagulopathy. While the known etiologies of disseminated intravascular coagulopathy are numerous, ischemic colitis is rarely presented as one.Table 1: Initial labsTable 2: Resolution of disseminated intravascular coagulopathy in a case of ischemic colitisFigure 1Figure 2