Ischemic Colitis Following Colonoscopy in an Elder Patient with Cardiovascular Disease

Abstract

This case is an 85 year-old female with hypertension, diabetes mellitus, cardiovascular disease, congestive heart failure and dementia. She was admitted for hematuria and low gastrointestinal bleeding, the computed tomography scan of the abdomen and pelvis revealed a transverse colon tumor. She received a colonoscopy that found the tumor made transverse colon almost completely obstruction. The pathology of tumor biopsy showed adenocarcinoma. Unfortunately, abdominal fullness, fever, severe leukocytosis developed one day after the colonoscopy and then hypotension was detected. There was no evidence of arrhythmia or acute coronary syndrome. A follow-up abdominal computed tomography revealed pneumatosis intestinalis at the distal transverse colon, splenic flexure and sigmoid colon, compatible with ischemic colitis. Despite intensive treatment including hydration, inotropic agent infusion, antibiotics therapy and ventilatory support, she died of soon multi-organ failure. Literatures were reviewed for discussion. Ischemic colitis is a rare complication of colonoscopy. The predisposing factors for developing ischemic colitis following colonoscopy include connective tissue disease, advanced age and cardiovascular disease. Ischemic colitis may rarely occur following a colonoscopy without these predisposing factors. For patients with risk factors, we should supply adequate fluids for them, do careful bowel preparation, avoid hyperinflation during the procedure and shorten the procedure time. Be aware of the possible complications including ischemic colitis after colonoscopy and do the proper management.