Ischemic Colitis Secondary to Extrinsic Compression by Large Ovarian Cystic Neoplasm

Abstract

Purpose: INTRODUCTION: Ischemic colitis is most often caused by inadequate colonic perfusion, either occlusive or non-occlusive. We describe an unusual mechanism of ischemic colitis namely, extrinsic compression on the colon by a large malignant mass. CASE: A 60 y/o Caucasian female developed recurrent ovarian carcinoma three years after the total abdominal hysterectomy with bilateral salpingo-oopherectomy and omentectomy. CT scan showed a large pelvic cystic mass, 12.5 × 13 cm extrinsically compressing the sigmoid colon and both ureters. There were hepatic cystic metastases as well. Cardiac function and hemodynamics were normal. Patient was on no vasospastic medications or NSAIDs. A colonoscopy was performed to evaluate new onset diarrhea, fecal incontinence and left lower quadrant abdominal pain. Colonoscopy revealed extrinsic compression on a sigmoid colon. There were mucosal ulcerations overlying the compressed portions of the sigmoid colon. Biopsies were consistent with ischemic colitis. A water soluble contrast lower GI x-ray revealed tight compression of sigmoid colon by the pelvic mass. Patient declined diverting colostomy and ultimately succumbed to her malignancy in hospice. DISCUSSION: Our patient had ischemic colitis in association with tight extrinsic compression on the involved colonic mucosa. This represents an unusual mechanism of ischemic colitis. We speculate that extrinsic compression interferes with blood flow to the colon by compressing serosal blood vessels, as well as by raising intramucosal pressure and thereby reducing mucosal perfusion. CONCLUSION: Tight extrinsic compression of the colon should be considered as a contributory cause in some cases of ischemic colitis.