Ischemic Colitis: Unreported Complication After a Carbon Dioxide Angiogram

Abstract

Introduction: Carbon dioxide is used as a contrast medium for angiography because it is highly soluble, rapidly absorbed and readily excreted by the lungs. CO2 angiography is used in patients who are allergic to iodinated contrast, have renal insufficiency or require high volume contrast procedures. Notable complications of CO2 angiography include air embolism, neurotoxicity, hypotension, nausea and abdominal discomfort. Transient ischemic colitis has not been reported as complication of CO2 angiography. Case: 75-year-old male with past medical history of hypertension, coronary artery disease (status post coronary artery bypass grafting) and chronic kidney disease presented to the emergency department with lower abdominal pain. The pain started about 30 minutes after CO2 angiography for evaluation of intermittent claudication. The pain was suprapubic and in the left lower quadrant and associated with vomiting. This was followed by bloody mucoid stools. WBC count was elevated at 14.7 with a left shift and the rest of the labs were unremarkable. Abdominal and pelvic CT scan without IV contrast showed diffuse colonic wall thickening in rectosigmoid area. Flexible sigmoidoscopy with an ultra scope showed friable mucosa, nodularity, cobblestoning and mucosal edema in the rectum and sigmoid. The findings were consistent with ischemic colitis. The patient was managed conservatively and improved over the next week and was uneventfully discharged. Conclusion: Ischemic colitis that has been reported after angiography can have potentially life threatening and serious complications. Transient ischemic colitis after CO2 angiography has not been reported before. In this case, the colonic ischemia was self limiting and short lived and responded well to conservative therapy.