Case Of Ischemic Colitis Research Articles

S2810 Colonic Deception: Two Cases of Ischemic Colitis Posing as Malignant Masses

S2810 Colonic Deception: Two Cases of Ischemic Colitis Posing as Malignant Masses

Secondary Anti-phospholipid Antibody Syndrome Due to Systemic Lupus Erythematosus: A Case Report with Superior Mesenteric Artery Involvement

Anti-phospholipid antibody syndrome (APS); is a disease characterized by anti-phospholipid protein antibody positivity as well as recurrent vascular thrombosis and/or pregnancy loss. In primary type, underlying disease is not detected. It is classified as secondary type in the presence of another underlying rheumatological disease. Secondary APS, most commonly develops due to systemic lupus erythematosus (SLE)1. We present a case of ischemic colitis due to superior mesenteric artery involvement in APS. 59-year-old female patient diagnosed with SLE had sudden-onset hematochezia and acute abdomen. Therefore, the patient underwent contrast-enhanced computed tomography angiography (CT angiography). Thrombosis was detected in the superior mesenteric artery. The patient with positive APS antibody responded to immunosuppressive therapy. This case was interesting in terms of different vascular involvement and treatment strategy in the gastrointestinal tract due to APS.

S2138 TACE-Induced Ischemic Colitis

Introduction: Transarterial chemoembolization (TACE) is a locoregional treatment used in patients with hepatocellular carcinoma (HCC). This therapy entails injecting a chemotherapeutic agent into a branch of the hepatic artery supplying blood to the tumor while cutting off blood supply through particle embolization. This procedure may be utilized in a patient who is not a candidate for surgical resection or as a bridge to liver transplantation. Here we present a case of a ischemic colitis in the setting of a recent TACE. Case Description/Methods: A 65-year-old female with history of HCC underwent an outpatient TACE procedure for a 3.6 cm liver lesion. Soon after the procedure the patient complained of severe abdominal pain and was admitted. On day 2 of hospitalization, she developed significant bright red blood per rectum. Computed tomography (CT) demonstrated mild wall thickening and pericolonic fat stranding in the ascending colon concerning for acute colitis. Lactic acid was elevated at 5.8 mmol/L (normal < 2). Colonoscopy demonstrated multiple ulcers and erythema stretching from the cecum to descending colon suggestive of ischemic colitis. Biopsies demonstrated superficial mucosal erosion and necrosis, crypt atrophy, and lamina propria hemorrhage with hyalinization, consistent with acute ischemic colitis. CT angiography demonstrated a patent abdominal aorta and all major branches. The patient was treated conservatively without further episodes of hematochezia and was discharged home (Figure). Discussion: Postembolization syndrome is the most common adverse effect of TACE, which occurs in 60 to 80 percent of patients. This has been reported to be related to either tumor necrosis or due to ischemic damage to normal liver parenchyma. One case of gastrointestinal ulceration has been reported after TACE. To date, there has been no reported case of ischemic colitis after TACE. This presentation of ischemic colitis in our patient may be due to regurgitation of embolized particles into superior mesenteric arterial circulation leading to hypoperfusion of the colon, resulting in ischemic colitis. One should consider this presentation on the differential diagnosis in a patient with hematochezia after TACE.Figure 1.: Ascending and transverse colon demonstrating multiple ulcers and erythema suggestive of ischemic colitis on colonoscopy.

Ischemic colitis related to antipsychotics : A rare and serious entity to know

IntroductionIschemic colitis is a rare condition. It represents 3 to 10% of lower digestive hemorrhages. It preferentially affects the subject over the age of 50 with predisposing factors. Rare cases have been reported in young subjects with the use of cocaine, combined hormones or antipsychotics.ObjectivesThis work aimed to study the potential side effects of antipsychoticsMethodsWe report a case of ischemic colitis associated with antipsychotics.ResultsA 27-year-old patient, followed for 2 years for schizophrenia treated with antipsychotics (chlorpromazine and haloperidol) and an antiparkinsonian (Biperiden), consulted in the emergency room for rectorragies progressing for 3 days. The examination revealed the installation of diffuse abdominal pain associated with early postprandial vomiting which preceded the 7-day rectal bleeding. The physical examination revealed ascites without edema of the lower extremities. The stools were normal-colored on digital rectal examination. The biological workup revealed anemia and a biological inflammatory syndrome. The abdomino-pelvic scanner showed thickening of the entire colonic wall with signs of recent bleeding. The rectosigmoidoscopy showed an ecchymotic aspect of the sigmoid with less pronounced involvement of the rectum. Pathologic examination of the colonic biopsies concluded with ischemic colitis, showing hemorrhagic suffisions with numerous fibrinous thrombi of the vessels. The course was marked by the onset of multi-organ failure with acute renal failure, a picture of disseminated intravascular coagulation (DIC) and alveolar hemorrhage. Despite the resuscitation, the patient died 2 days after admission.ConclusionsIschemic colitis is a rare side effect of antipsychotics. Although rare, this entity should be evoked and diagnosed in time.DisclosureNo significant relationships.

Ischemic Colitis induced by COVID-19: A Case Report

COVID-19 has been associated with coagulation disorders which add further to the morbidity and mortality caused by the disease itself. Ischemic colitis can result from hypercoagulable states. In this report we present a rare case of ischemic colitis induced by COVID-19 in 27-year-old male. Patient presented with severe generalized abdominal pain. CT abdomen showed filling defects, absent enhancement indicating venous bowel ischemia. CT-angiograph revealed complete thrombosis of portal, splenic, superior and inferior mesenteric veins. Patient was shifted to intensive care unit and kept nothing per orum. He was given Heparin, tramadol and paracetamol intravenously. COVID-19 Reverse transcription–polymerase chain reaction (RT–PCR) was positive. He was then given Favipiravir through nasogastric (NG) tube. On 4th day NG was removed and patient was subsequently discharged on 9th day. COVID-19 may lead to hypercoagulable states and gastrointestinal complications. COVID-19 patients with gastrointestinal symptoms should be evaluated carefully for possible ischemia.

Acute right-sided ischemic colitis in a COVID-19 patient: a case report\xa0and review of the literature

IntroductionIn addition to attacking the respiratory system, the coronavirus disease may attack the gastrointestinal tract in various ways, one of which is by creating a coagulopathy that may lead to acute ischemia of the bowel, increasing morbidity and mortality rates in these patients.Presentation of caseWe present a case of a white 72-year-old European male, who was admitted to the intensive care unit after developing COVID-19-induced acute respiratory distress syndrome. On the third week, despite a favorable evolution of his respiratory symptoms, the patient became clinically septic; laboratory findings showed an augmentation of his d-dimer, fibrinogen, C-reactive protein, and procalcitonin levels. Imaging showed signs of ischemia of the right colon. The patient was taken to the operating room; only the right side of his colon was ischemic, with a well demarcated cut-off. A laparoscopic right hemicolectomy with a terminal ileostomy was performed. The patient was able to go home 2 weeks after surgery.Discussion and conclusionIschemic colitis is an uncommon pathology in the general population, and is rare in COVID-19 patients. Most cases of ischemic colitis in COVID-19 patients in the literature were limited to the left colon, with < 10 cases involving the right colon. Accurate and quick diagnosis with appropriate management is the key to avoid any mortality in those patients who are already weakened by the coronavirus.

IBD MIMICS PRESENTED AT IBD LIVE: WHEN IT IS NOT INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND A group of Inflammatory Bowel Disease (IBD) specialists have been utilizing a weekly live video conference “IBD Live” to discuss multidisciplinary management of challenging cases. Since 2009 the conference has featured robust interactive case discussions among 150-200 gastroenterologists and colorectal surgeons from multiple academic institutions. Although the majority of cases presented are IBD, there have been a number of cases where IBD was not the ultimate diagnosis. Hence, we sought to characterize these “IBD mimics” to provide a structure for differential diagnosis. METHODS All 106 hours of case conferences recorded and archived between May 2018 and June 2021 were reviewed. A total of 183 of the 215 cases discussed had an IBD diagnosis including 124 Crohn’s disease (CD), 54 ulcerative colitis (UC) and 5 IBD unclassified. RESULTS Many of the remaining 32 (14.9%) cases (Table 1) were referred to a specialist with a prior diagnosis of IBD. There were 10 cases of colonic inflammation initially diagnosed as UC. Etiologies included drug-induced colitis secondary to checkpoint inhibitors for cancers, ocrelizumab for multiple sclerosis, and nintedanib for pulmonary fibrosis. There were cases of ischemic colitis, idiopathic myointimal hyperplasia of mesenteric veins, segmental colitis associated with diverticulosis, and diversion colitis. There were 8 cases of systemic diseases, diagnosed as Common Variable Immunodeficiency, sarcoidosis and vasculitis, including cases of Henoch–Schönlein purpura and CTLA4 haploinsufficiency with autoimmune infiltrates. There were 5 cases of ileal disorders, ultimately diagnosed as lymphoma, tuberculosis, Meckel’s diverticulum, and appendiceal carcinoid all previously thought to be CD. There were small bowel mucosal disorders including collagenous sprue and autoimmune enteropathy, and 2 polyposis cases secondary to Cronkhite-Canada and juvenile polyposis syndromes. There were also cases thought to be penetrating complications of CD, including a case of abdominal actinomyces infection. Finally, there were 3 cases where no consensus diagnosis was made, with broad differential diagnoses including cryptogenic multifocal ulcerous stenosis enteritis. CONCLUSIONS IBD mimics were found in 15% of cases presented at a global IBD webinar in a 3-year period. Clinicians should have a high level of suspicion and actively pursue alternative etiologies when patients do not respond as anticipated to IBD therapy and/or when the disease characteristics are not completely consistent with IBD. These non-IBD diagnoses will lead to a significant change in medical, surgical and pharmacological treatment approaches, which will impact total cost, unplanned care and quality. Our IBD Live conference has positively impacted the care of our patients, and magnified the importance of considering a broad differential for IBD "mimics."

A Case of Ischemic Colitis on the Anal Side of the Anastomosis after Laparoscopic Sigmoidectomy

A Case of Ischemic Colitis on the Anal Side of the Anastomosis after Laparoscopic Sigmoidectomy

Oral-contraceptive related ischemic colitis in young women: A case report

Ischemic colitis is the most common form of gastrointestinal (GI) ischemia. The mechanism of ischemic colitis is the lack of colonic blood supply, and the causes are numerous and can be divided into two groups: vascular occlusive and non-occlusive diseases. Despite being common in elderly patients, ischemic colitis is rare in the young and usually associated with some estrogenic drugs, sickle cell anemia, vasculitis, and lupus erythematosus. In Vietnam, estrogen is a rare cause of ischemic colitis. We encountered a clinical case of ischemic colitis in a young female patient taken oral contraceptives for a long time. She visited the hospital for acute abdominal pain and bloody stools. Blood tests and abdominal computed tomography were normal. Endoscopy appearance showed a “single-stripe” sign at the descending colon to the splenic flexure. The biopsy result revealed acute mucosal damage. The patient was managed conservatively with bowel rest, intravenous fluids, and empirical antibiotics. The symptoms were improved with abdominal pain relief and yellow stools after four days. Through this case report, we warn about the risk of ischemic colitis in young women taking oral contraceptives

A Case of Ischemic Colitis Due to Venous Stasis Occurring Half a Year after Laparoscopic Sigmoidectomy

A Case of Ischemic Colitis Due to Venous Stasis Occurring Half a Year after Laparoscopic Sigmoidectomy

1608 Double Trouble: A Rare Case of Recurrent Ischemic Colitis Due to Pseudoephedrine

INTRODUCTION: There are 10 reported cases of ischemic colitis due to pseudoephedrine. We present the first case of recurrent ischemic colitis due to pseudoephedrine. CASE DESCRIPTION/METHODS: A 64-year-old female with past medical history of hypertension, seasonal allergies presented to the ED with two days of worsening severe left lower quadrant pain and hematochezia. Her medications included rosuvastatin, HCTZ, and fexofenadine hydrochloride/pseudoephedrine hydrochloride (Allegra-D). On admission she was afebrile and normotensive. Physical exam showed mild tenderness in the left lower quadrant, no rebound tenderness, rigidity or peritoneal signs. Hemoglobin was 14.9 g/dL with leukocytosis at 15,100/µl. A CMP, hepatic panel, and pancreatic enzymes were unremarkable. A CT scan revealed diffuse edema with surrounding infiltration of fat in the bowel in the region of the splenic flexure and proximal descending colon, consistent with ischemic colitis. Patient was made NPO and started on IV fluids and antibiotics. Her bleeding subsided. It was suspected that the pseudoephedrine in the Allegra-D may have induced vasoconstriction of the bowel. Allegra-D was discontinued and she improved with conservative care and discharged four days later. She was advised to avoid vasoconstrictors such as pseudoephedrine and switched from Allegra-D to Allegra. Unfortunately, seven years later the patient presented again with similar complaints of abdominal pain and hematochezia. She reported taking Claritin-D (loratadine and pseudoephedrine) for allergies. A CT angiogram displayed normal vasculature. A colonoscopy showed ulcers in the sigmoid area with denuded mucosa with sharp margins. Biopsy revealed colonic inflammation, regenerative changes of the crypt with mucin depletion, and the presence of a fibrin thrombus. These findings were consistent with ischemic colitis. The patient had a score of 11 on the Naranjo Scale suggesting that the ischemic colitis was caused by an adverse drug reaction. She was switched from Claritin-D to regular Claritin and symptoms resolved without hospitalization. DISCUSSION: It is unprecedented for a patient to have unintentional pseudoephedrine induced ischemic colitis on two separate occasions. The minute nuances in branding can mislead patients into thinking that a medication does not contain certain agents – in this case pseudoephedrine – and lead to adverse health outcomes. It is our duty to carefully reconcile these medications, and educate patients in order to prevent such adverse events.

Hypogastric artery coverage during endovascular aneurysm repair in octogenarian and younger patients.

To report our experience about hypogastric artery coverage during endovascular aneurysm repair (EVAR) for aortoiliac aneurysms in patients younger than 80 years (group A) compared with octogenarian patients (group B). Data of consecutive EVAR with hypogastric artery coverage from 01/1998 to 12/2016 were retrospectively analyzed. Primary outcomes were the occurrence of ischemic colitis, type II endoleak and buttock claudication both at 30 days and in the long term. P values less than 0.05 were considered statistically significant. The hypogastric artery was covered in 107 patients. Twenty-three (21.5%) were octogenarian (group B). At 30 days, one type II endoleak occurred in group B, whereas 16 patients of group A experienced buttock claudication. There were no cases of ischemic colitis. During follow-up (median 63.5 months), no cases of ischemic colitis occurred. Six new type II endoleaks were recorded (five in group B and one in group A, P = 0.0001). Buttock claudication persisted in four patients of group A. No new cases of buttock claudication were observed. Unilateral hypogastric artery coverage during EVAR for aortoiliac aneurysms can be performed with an acceptable rate of postoperative complication. Postoperative buttock claudication was more frequent in younger patients, whereas a type II endoleak occurred mostly in octogenarian patients during follow-up.

Ischemic colitis in a known sickle cell disease patient

Patients affected with sickle cell disease (SCD) suffer from recurrent vascular occlusions that lead to ischemia and distal tissue infarction in multiple organs. These vascular occlusions manifest as sickle cell pain crises. Abdominal pain is common in sickle cell pain crises. It is attributed to vasoocclusion or infarction in the mesenteric vasculature. Progression to significant ischemic damage of the intestine is rare in sickle cell disease. The objective was to show the rare case of ischemic colitis in SCD patient. The patient’s images (plain abdominal x rays and barium enema images) and case file were reviewed and summarized. The subject matter of ischemic colitis in a known SCD was reviewed in the literature. The index case was discussed and compared with literature. We report an 18-year-old known SCD patient diagnosed since childhood but not regular on medication and follow up. The patient presented to SCD clinic of Aminu Kano Teaching Hospital (AKTH), Kano with 2-year history of recurrent blood stained and watery stool associated with abdominal pain and low-grade fever. There was history of easy fatigability and multiple blood transfusions in the past. Other systemic reviews were unremarkable. This man is the only sickle cell anemic child among 9 other siblings of the family, and on presentation, a second-year student of a junior secondary school. Examination revealed a stunted young man, mild pale with a tinge of jaundice. Abdominal examination revealed hepatomegaly 4 cm below the costal margin. The spleen was not enlarged. Other systemic reviews were unremarkable. Latest hemoglobin was 5.7 g/dL. Renal and the liver function tests were normal. Stool microscopy did not isolate ova, cyst or protozoa. Barium enema was then requested and showed loss of haustration and cobblestone appearance involving the entire colon. Fine mucosal granulations were also noted in the rectum. Diagnosis of colitis most probably ischemic was made. The patient was commenced on analgesics and antibiotics including azithromycin and metronidazole and made significant improvement. Ischemic colitis in SCD may still be encountered in practice despite its rarity.

Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with 9 years of data from the National Surgical Quality Improvement Program

BackgroundThe American College of Surgeons' National Quality Improvement Program (NSQIP) database can be used to assess trends and outcomes of ruptured abdominal aortic aneurysm (rAAA) repair. The purpose of this study is to examine the morbidity and mortality for ruptured endovascular (rEVAR) and ruptured open (rOPEN) aneurysm repair compared with elective endovascular (EVAR) and elective open (OPEN) aneurysm repair. MethodsRuptured and nonruptured abdominal aortic aneurysms were identified from the NSQIP database between 2008 and 2016. Data regarding demographics and comorbidities, 30-day mortality, and postoperative complications were collected for rEVAR, rOPEN, EVAR, and OPEN cases. ResultsThere were 43,105 AAAs, 34,177 (79.28%) EVARs, and 8928 (20.71%) OPENs. There were 3806 rAAAs, 1843 (48.42%) rEVARs, and 1963 (51.58%) rOPENs. The incidence of rEVAR repair lagged behind EVAR considerably. Mortality for rOPEN was 575 (29.29%) and 344 (18.66%) for rEVAR. No difference between the ratio of men to women in rOPEN vs rEVAR was noted. There was a significant increase in mortality for women vs men undergoing rEVAR (P = .0362). No difference in mortality existed between women vs men undergoing rOPEN (P = .0639). There was no difference in the percentage of hypotensive cases undergoing rEVAR vs rOPEN (P =.1873). For all rAAAs with hypotension, rOPEN had an increased mortality compared to rEVAR (P = .0004). There were 20 (3.11%) rEVAR and 40 (8.00%) rOPEN cases with lower extremity ischemia. rOPEN conferred a significant increase in lower extremity ischemia (P = .0002). There were 46 (7.15%) rEVAR and 60 (12.00%) rOPEN cases of ischemic colitis. rOPEN had a significant increase in ischemic colitis (P = .0052). ConclusionsNSQIP data, over 9 years, demonstrate an increased morbidity and mortality associated with open vs endovascular repair of rAAAs. A great disparity exists between the proportion of rEVAR and rOPEN to EVAR and OPEN. The lagging use of endovascular repair of rAAAs must be further explored.

Tomodensitometric Aspects of Acute Intestinal Ischemia: A Prospective Study of 20 Cases

Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis is known to be difficult at the early stage during which a well-conducted treatment may help reduce mortality. Multi-detector scanners were assessed to be far more sensitive and appropriate for the diagnosis of mesenteric ischemia than angiography. Objective: Study the tomodensitometric aspects of acute intestinal ischemia, and the traps of late diagnosis, in order to optimize the care and improve the prognosis of this disease. Patients and Methods: This is a prospective, longitudinal and descriptive study covering a period of nine (9) months. We have included all cases of acute intestinal ischemia. Results: Twenty (20) cases of acute intestinal ischemia were registered i.e. a frequency of 2.2 cases per month. The average age of the patients was 67.8 years with 0.7 as sex ratio. Abdominal pain was noted in all cases. History of cardiovascular disease was found in seven (7) cases. Abdominal angioscan was performed in fifteen (15) cases. There was a suspected diagnosis upon request in ten (10) cases. The main intestinal lesions were the lack of parietal enhancement (13 cases) and parietal thickening (12 cases). There were sixteen (16) cases of acute mesenteric ischemia and four (4) cases of ischemic colitis. The acute mesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases and mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction in eleven (11) cases. Ten (10) patients were operated and 10 others were treated medically. Thirteen (13) cases of death were registered. Conclusion: Acute intestinal ischemia is a rare but serious disease. Abdominal pain is the main ground for consultation. Diagnosis is often late and focuses on abdominal CT angiography. An early diagnosis could help improve its prognosis.

Colonic Ischemia: A Rare Occurrence Following Vaginal Delivery

Ischemic colitis is a type of intestinal ischemia typically associated with vasculopathy in advanced age. While some predisposing factors can increase the risk of disease, ischemic colitis is uncommon in young adults. Furthermore, cases of ischemic colitis associated with pregnancy are exceedingly rare. We present a case of ischemic colitis in a young woman following vaginal delivery that ultimately led to sigmoid resection due to persistent stricturing. A 29-year-old female with chronic HCV infection from past IVDU underwent a vacuum-assisted vaginal delivery of a term pregnancy. Following delivery, she developed severe LLQ abdominal pain and bloody diarrhea. Flexible sigmoidoscopy on postpartum day 1 found dark discoloration and extensive mucosal edema of the left colon suggestive of ischemia. Histology revealed active colitis with ulcerative debris and gland dropout. After ruling out other potential causes, she was diagnosed with acute ischemic colitis and treated conservatively. The patient eventually left the hospital in stable condition, but she continued to experience symptoms in the weeks following discharge. Surveillance colonoscopy later revealed a tight stricture in the sigmoid colon that had formed because of recent ischemia. Efforts to dilate and traverse the stricture endoscopically were unsuccessful. The patient was referred to colorectal surgery and underwent a laparoscopic sigmoid colectomy. Gross pathology of the surgical specimen showed ulceration, inflamed granulation tissue, and glandular disarray consistent with ischemia and chronic colitis. A month after her surgery, the patient was seen in the office and was reported to be doing well. Reports of ischemic colitis associated with pregnancy in the literature are scarce and limited clinical data has made it difficult to definitively establish the underlying pathophysiology. Based on several documented cases of transient ischemic colitis in women taking oral contraceptives, current literature suggests that an estrogen-induced hypercoagulable state may play a role. The same underlying mechanism links excess estrogen from oral contraceptives with a risk of forming thromboemboli. Whether this mechanism was the cause in our case remains unclear. Physicians should be mindful of the physiologic changes that occur during pregnancy. And although it is rare, ischemic colitis should be considered in the differential when treating pregnant patients who complain of abdominal pain and bloody diarrhea.

Risk Factors, Presentation, Diagnosis and Management Factors Associated With Surgery and Death in Ischemic Colitis Patients: A Retrospective Cohort Study

Introduction: Colonic ischemia affects older patients with co-morbidities and is usually benign and selflimited but, in certain patients, it can be fatal. It should be suspected in any patient who presents with acute abdominal pain and bloody diarrhea and is usually diagnosed imaging and with colonoscopy and histology, which is the gold standard. This study reviewed a cohort of ischemic colitis patients from St Josephs’ Hospital in Hamilton Ontario. Methods: We searched all suspected cases of ischemic colitis based on diagnostic codes from admissions at St Joseph’s Healthcare from 2010 to 2017. The patient records were reviewed, and clinical data collected and analyzed regarding their admission. Patient where excluded if an alternative diagnosis is made or if there was not enough information recorded to make a final diagnosis. The diagnosis is made based on imaging or colonoscopy with histology. Results: A total of 693 patients were identified, and after exclusion, 144 were reviewed for analysis. The mean age was 70.1 years (range 27-99, SD 15), and mean length of admission was 12 days (range 0-119). Most common patient symptoms were abdominal pain (119), hematochezia (95), change in bowels (36), and vomiting (34). Comorbidities included 73% with hypertension, 44% with dyslipidemia, 31% with coronary disease, and 27% with diabetes. A diagnostic CT was done in 93 patients (65%), and a colonoscopy in 79 (55%). Antibiotics were used in 43% of patients and blood transfusion required in 7%. Mortality was 16.6% and surgery was 15.9%. Complications of sepsis were 10.4% and acute kidney injury in 6.3%. Logistic regression for factors associated with death were significant for complications of sepsis (p=0.004), prolonged INR on presentation (p=0.02), and history of atrial fibrillation (p=0.03). Risk for surgery has been significantly related with sepsis (p= 0.026). COPD was the only significant factor (p=0.005) for increasing length of stay. Conclusion: Ischemic colitis was associated with mortality of 16.6% and 15.9% risk of surgery. Awareness of risk factors for poor outcome may help identify high risk patients. In our study, death was associated with patients who presented with elevated INR, past history of atrial fibrillation and those who developed sepsis.

Ischemic colitis caused by polycythemia vera: A case report and literature review.

Polycythemia vera (PV) is a chronic myeloproliferative disorder originating from hematopoietic stem cells and complicated by thrombosis and bleeding. This report describes a case of ischemic colitis (IC) caused by PV and includes a review of the relevant literature. The patient was a 59-year-old male with a history of PV who presented with abdominal pain and hematochezia. Colonoscopy and histopathological examination results indicated suspected ischemic bowel disease. Following experimental anticoagulant therapy for 7 days, the patient no longer experienced abdominal pain and hematochezia had resolved. Colonoscopy review showed no obvious anomalies 1 month later. These data demonstrated that PV is an uncommon cause of IC.

A Case of Ischemic Colitis Associated with Abnormally Elevated Serum CEA Levels

A Case of Ischemic Colitis Associated with Abnormally Elevated Serum CEA Levels

A Case of Ischemic Colitis of the Residual Colon after Rectal and Transverse Colon Cancer Surgery

症例は65歳女性，10年前に直腸癌Rs pT2N0M0 pStage Ⅰに対して低位前方切除術（D3郭清，両側側方郭清あり，左結腸動脈温存），受診３カ月前に肝彎曲部の横行結腸癌pT4N0M0 pStage Ⅱに対して結腸右半切除術（D3郭清，中結腸動脈左枝温存）を他院にて施行した手術既往がある．結腸右半切除術後から下痢と食思不振が出現し，前医で入退院を繰り返していたが，転居に伴い当科を紹介受診した．造影CTでは残結腸炎を認め，中結腸動脈左枝や左結腸動脈は同定できなかったが，残結腸から下腸間膜静脈へ環流する静脈はあり，血流は保たれていると考えられた．注腸造影検査では直腸吻合部より近位側の残結腸に，遠位側に優位な狭窄を認めた．残結腸の虚血性大腸炎と診断，数カ月間の保存的加療で改善がなく，低栄養状態を伴うことから，残結腸全摘術と回腸人工肛門造設術を施行した．術後は経過良好で，初診時1.7g/dlだったアルブミン値は術後11日目には2.7g/dlまで上昇し，栄養状態と共に浮腫も改善して，軽快退院となった．さらに，２カ月後には施設基準値の3.9g/dlまで改善を認めた．大腸癌術後に生じた虚血性大腸炎は報告例が少ない．今回われわれは２回の大腸癌手術後に生じた虚血性大腸炎の症例を経験したため，若干の文献的考察を加えて報告する．