Cause Of Ischemic Colitis Research Articles

S3474 Sevelamer-Induced Ischemic Ulcerative Colitis

Introduction: Sevelamer is phosphate binder used to treat hyperphosphatemia in patients with end stage renal disease (ESRD) on hemodialysis. Rarely, it has been shown to be a cause of ischemic colitis. This case provides an example of a patient presentation and key findings when considering sevelamer induced small bowel ischemic colitis. Case Description/Methods: A thirty-five-year-old male with ESRD on peritoneal dialysis presented with two days of hematochezia and severe abdominal pain. Diarrhea is described as maroon colored with four episodes in the span of 24 hours. Infectious work-up, including clostridium difficile and comprehensive GI panel, was negative for acute infection. CRP was elevated to 42.6 mg/L, WBC 12.9 10*3/uL, and hemoglobin 7.5 g/dL. CT angiography of the abdomen showed two short segments in the small bowel with inflammation concerning for ischemia. Colonoscopy and push enteroscopy were performed on day three of hospitalization showing ulcerative inflammation in D4 and in the terminal ileum 6cm proximal to the ileocecal valve. Biopsy results at the terminal ileum and D4 were showed mucosal necrosis and acute inflammation with crystalloid structures consistent with pill-associated mucosal necrosis. Further history was obtained from patient, he had been started on sevelamer a few weeks prior to hospitalization. Sevelamer was discontinued resulting in resolution of patient’s symptoms (Figure). Discussion: Although a rare complication, sevelamer has been documented to cause ischemic colitis (Yuste, Keri). These patients present similarly to the one discussed above with melena and abdominal pain. One of the hallmark findings reported on histopathological exam is “fish-scale” crystalloid structures in the mucosa. A review from 2017 examined published case reports in which sevelamer had caused ischemic colitis and the crystalloid structures were present in 13 out of 16 patients (Yuste). In ESRD patients on sevelamer, who present with symptoms consistent with gastrointestinal bleeding, it is important to recognize the sevelamer as a cause of ischemic colitis and to stop the sevelamer immediately. Furthermore, video capsule endoscopy or push enteroscopy should be considered if standard upper endoscopy and colonoscopy do not identify the source, as sevelamer induced enteritis can occur throughout the intestinal tract. If sevelamer is not stopped, complications such as perforation, acute anemia, stricture formation, and ulceration can continue to occur and worsen.Figure 1.: A) Diffuse ulcerated mucosa of the fourth portion of the duodenum. B) Patchy ulcerations of the terminal ileum. C) Terminal ileum biopsy showing crystalloid structures in an area of necrosis suspicious for pill-associated mucosal necrosis.

S2050 Inferior Mesenteric Arteriovenous Fistula Treated with Embolization

Introduction: Inferior mesenteric arteriovenous fistulous malformations are a rare yet reversible cause of ischemic colitis. They can cause increased outflow of blood in the venous circulation and predispose to colon ischemia. We report a case of inferior mesenteric arteriovenous fistula causing ischemic colitis in an atypical distribution in the IMA territory. Case Description/Methods: A 50-year-old gentleman presented to the emergency room with a 3-week history of abdominal pain and bloody diarrhea. His symptoms started with a dull pain, 8/10 in intensity, with radiation to his lower back. He had also been having a low appetite for the duration of his abdominal pain. He described having around 10 bowel movements daily with blood mixed with mucus. CT abdomen showed diffuse circumferential thickening involving the entire sigmoid colon, extending to the upper rectum suggesting non-specific colitis. He came to the hospital 2 weeks prior to his presentation and underwent a colonoscopy which grossly showed diffuse severe inflammation in the distal descending colon, sigmoid colon and proximal rectum, till 30 cm from the anal verge suggesting left-sided colitis. Biopsied from the region showed evidence of ischemic colitis. His CT-angiography showed engorgement of the IMA and IMV, with an early contrast in IMV which suggested IMA to IMV AV fistula within the left hemipelvis. That suggested vascular malformation as the cause of the colorectal findings. Patient subsequently underwent embolization of 2 branches of IMA with stent placement in IMA, causing closure of the AV fistula. Patient tolerated the procedure without any complication (Figure). Discussion: Ischemic colitis is most commonly seen in the watershed areas of the colon such as splenic flexure and rectosigmoid junction due to arterial anastomosis between the mesenteric arteries supplying the colon. In these situations, the colonic involvement is focal involves these specific segments. In this case, patient had diffuse gross ischemic findings from the distal rectum extending to descending colon involving the whole part of ischemic artery supply which is atypical for the distribution of colonic ischemia. In such situations, CT angiography comes as a diagnostic tool for identifying the pathology and in this situation it showed AV fistula between IMA and IMV which hampered the colonic blood supply to the extent to cause ischemic colitis with symptoms.Figure 1.: a. Early filling of dilated mesenteric veins (bottom arrow) with adjacent bowel wall edema due to venous congestion (top arrow) b & c. inferior mesenteric artery (arrows) adjacent to ill-defined area of contrast (dashed arrow) thought to represent arterio-venous fistula d. view from sigmoidoscopy showing ischemic colitis in the sigmoid colon.

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

905 Inferior Mesenteric Artery Branch Aneurysm Causing Ischemic Colitis – A Sequela of Anabolic Steroid Use

Abstract An inferior mesenteric artery (IMA) aneurysm comprises less than 1% of all reported visceral artery aneurysms. A 34-year-old bodybuilder with a history of anabolic steroid (AS) use of unknown duration, dose and frequency initially presented to the hospital with recurrent bouts of acute onset abdominal pain and alternating episodes of watery-mucous diarrhoea and constipation. Patient’s medical history was otherwise unremarkable with no stigmata of any connective tissue disorders. A diagnosis of ischemic colitis secondary to a distal IMA branch aneurysm measuring 6mm x 5mm x 10mm on CT was made three years after first presentation. Flexible sigmoidoscopy confirmed mucosal changes consistent with sigmoid ischemic colitis. A robotic anterior resection was performed due to two failed attempts at coiling the aneurysm. The histology was consistent with a secondary fibromuscular dysplasia in the IMA and its branches. There was a resolution of symptoms and return to normal stool and bowel function post-operatively. The commonest cause of an IMA aneurysm is the “jet disorder” phenomenon caused by incomplete atherosclerotic occlusion of the superior mesenteric (SMA) and celiac arteries (CA). While the link between AS use and dyslipidaemia is established, the patient’s lipid profile was normal. We believe this case lends valuable insight into atypical causes of ischemic colitis and adds to the literature on AS use and vascular pathology.

Tocilizumab as a possible cause of ischemic colitis

Tocilizumab as a possible cause of ischemic colitis

A rare cause of ischemic colitis: A case series of idiopathic mesenteric phlebosclerotic colitis from two medical centers in Taiwan

AbstractIdiopathic mesenteric phlebosclerotic colitis (IMP) is a rare disease entity of intestinal ischemia that is predominant in Asian populations. We present the clinical features, diagnosis, treatment, and outcome of this disease via a case series. We collected data from medical records in two medical centers in Taiwan. From 2008 to 2017, 11 cases were diagnosed with IMP, and their clinical features were analyzed. Eleven cases were included in our case series. The average age of the patients was 59 (±6.77) years old, and there was a predominance of women. More than half of our patients had a history of herb consumption. Their symptoms varied from asymptomatic to lethal, such as mechanical ileus. The most common colonoscopic finding was the dark purple discoloration and decreased vascularity over the edematous mucosa. In our case series, nine patients showed no disease progression after conservative treatment alone. In contrast, two cases required surgical intervention due to mechanical ileus. The symptoms of IMP may vary extremely, and it may present as asymptomatic or lethal. The etiology of this rare disease remained unknown, and some offending materials such as herb were considered responsible for its genesis. Both the specific radiological and colonoscopic characteristics helped to confirm its diagnosis. IMP should be always considered for ischemic colitis in long‐term herb users.

1633 Extensive Colonic Ischemia Due to Sumatriptan: An Unusual Adverse Effect

INTRODUCTION: Ischemic colitis (IC) is attributed to variety of etiologies including hypo-perforation due to dehydration, sepsis; thrombosis and embolic/thrombotic arterial occlusion. Pharmacological agents like 5Hydroxytryptamine1 (5HT 1) receptor agonists including Sumatriptan, widely used for refractory headaches, have also been known to be a cause of IC in rare circumstances. There are approximately 12 cases of IC reported which are related to 5 HT1 use. We are reporting a case of IC, which is likely related to long-term use of Sumatriptan. CASE DESCRIPTION/METHODS: A 39-year-old female with no significant past medical history was admitted to medical floor due to diffuse crampy abdominal pain and bloody diarrhea. Laboratory workup shows WBC 11500 cell/ml and negative IBD serology. CT of the abdomen and pelvis revealed pan-colitis. Stool culture and C. Difficile DNA were negative. Colonoscopy performed during admission revealed severe colitis involving entire colon except the rectum and distal sigmoid colon, biopsy featured ischemic colitis. A mesenteric Doppler ultrasound was ordered which was not conclusive, subsequently CTA performed which showed no mesenteric vascular stenosis. She was not on oral contraceptive pills and through careful questioning she mentioned that she had been taking Sumatriptan for a while. Due to the presumed association between Sumatriptan and IC, Sumatriptan was discontinued. She was emperically started on mesalamine and steroid, which were discontinued. Her symptoms improved with conservative management. A repeat colonoscopy in a few months after her hospital discharge did not show any colitis or ileitis; random colonic biopsies were unremarkable while she was off sumatriptan. DISCUSSION: Although rare, Sumatriptan use can be associated with IC, therefore we should be vigilant in reviewing medication lists in situations where there is no obvious etiology. Incidence of drug-related ischemia might be more than reported. It is imperative to counsel about meidcation adverse effect and reporting adverse effects.

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.

Gastrointestinal: Phlebosclerotic colitis: A rare but increasingly recognized cause of ischemic colitis with telltale imaging features.

Gastrointestinal: Phlebosclerotic colitis: A rare but increasingly recognized cause of ischemic colitis with telltale imaging features.

A Case of Idiopathic Myointimal Hyperplasia

A 61 year-old man presented with complaints of abdominal pain and dark, tarry stools for 1 week. He was first admitted for similar complaints 18 months prior, was diagnosed with perforated ischemic colitis, and underwent an emergent proctosigmoidectomy. Histopathology from the colon showed focal ulceration, crypt atrophy, and lamina propria fibrosis suggestive of acute and chronic ischemic injury, as well as myointimal hyperplasia of medium sized veins in the muscularis propria and serosa, consistent with a diagnosis of idiopathic myointimal hyperplasia of the mesenteric veins (IMH). 2 months before presenting to our institution, he underwent ostomy reversal with anastomosis of his remaining colon. On his presentation to our instutiont, colonoscopy revealed ulcerated mucosa at the anastomotic site consistent with ischemic injury. Histopathology was consistent with acute on chronic ischemic injury and IMH. He was re-admitted within one month for an unrelated complete - at this time he denied rectal pain or bloody stool. IMH is a very rare cause of ischemic colitis. First described in 1991, fewer than 30 cases have been published. It's most common presentation is bloody diarrhea, weight loss, and chronic abdominal pain. It is often misdiagnosed as inflammatory bowel disease. Endoscopically, IMH usually presents with ulcerated mucosa, friability, and an inflammatory exudate similar to ulcerative colitis (UC). On pathologic examination, IMH shares characteristics with Crohn's disease - specifically crypt atrpohy and fibrosis within the lamina propia. However the pathognomonic finding of IMH is muscular thickening of intramural veins. Additionally, treatment of IMH and IBD is vastly different. IMH has not been reported to improve with standard IBD treatments. Surgery is the only known therapy. It is curative, with no reports of post-surgical recurrence. However, given the lack of recognition of IMH amongst hospital providers, there is often a delay in diagnosis resulting in many unnecessary complications of ischemic colitis. IMH is an extremely rare disease, usually involving the colon. It shares many clinical, endoscopic, pathologic, and epidemiologic characteristics with IBD, and is often initially misdiagnosed as IBD. Increased awareness of this disease among hospital physicians may lead to earlier detection and curative resection, thus avoiding a prolonged work-up and potential complications from chronic ischemia.

Ischemic Colitis Managed by Serum-Derived Bovine Immunoglobulin/Protein Isolate

There are numerous causes of ischemic colitis, including compromised vascular circulation due to disease or certain medications which can elicit a reflex mesenteric vasoconstriction and result in diarrhea. Reported are 2 cases which detail the outcomes of including serum-derived bovine immunoglobulin/protein isolate (SBI) for the nutritional management of ischemic colitis with chronic loose and frequent stools. SBI has a unique mechanism which includes binding microbial components, maintaining normal GI immune balance, managing barrier function and improving nutrient utilization which may be useful in the management of ischemic colitis. Patient 1 was 82-year-old Caucasian female with a history of hypertension, diabetes mellitus and irritable bowel syndrome with diarrhea (IBS-D), with 4-5 bowel movements (BM)/day for 20 years. She was previously treated with dicyclomine and tricyclic antidepressants for 7 years. Her diarrhea worsened over the past 4 months to ˜10 BM/day. Because of the change in patient's chronic symptoms, a colonoscopy was performed, revealing mild to moderate colitis secondary to ischemia (Figure 1). Patient 2 was a 74-year-old African American male with ESRD/CAD/PVD admitted to hospital with an episode of rectal bleeding. Colonoscopy revealed ischemic colitis and the patient was discharged. He then developed diarrhea (5-6 BM/day). Clostridium difficile was negative by PCR so the patient was started on cholestyramine to help resolve the diarrhea but could not tolerate treatment. For both patients, SBI 5g QD was administered and the response reported here. Patient 1's BM improved to 2-3/day within 4 weeks. A repeat colonoscopy was performed 2 months after initiating SBI therapy and there was no evidence of colonic inflammation or ulcers (Figure 1). Patient 2's symptoms improved dramatically within a couple weeks, with fully formed stools (1-2 BM/day). Both patients continue on SBI 5g QD therapy for management of their condition and remain stable. Previously published reports of SBI in chronic mesenteric ischemia and other intestinal disorders support these patient observations. Although mesenteric ischemia can resolve on its own, the outcomes of these cases and the temporal nature of SBI administration suggest that these patients with ischemic colitis and associated chronic, loose stools may have benefited from this nutritional intervention. A well-controlled study in mesenteric ischemia patients is advised.Figure 1

Mo2021 The Role of Hypercoagulability in Ischemic Colitis

Introduction: Ischemic colitis (IC) is one of the most common gastrointestinal vascular diseases in the world. IC can result from alterations in the systemic circulation or from anatomic or functional changes in the mesenteric vasculature. On the other hand, an increasing diversity of causes of IC has been reported, including hematologic disorders, thrombophilic conditions, and medications. The aim of this study is to evaluate the role of thrombophiliahypercoagulability in IC. Methods: A prospective study of 56 patients with IC (diagnosis was established from clinical, endoscopic and pathologic (biopsy proven or compatible with IC) findings) who were evaluated for protein C (PC), protein S (PS), antithrombin (AT), resistance to activated protein C (APCR), lupus anticoagulant (LA), factor V G1691Amutation (FV Leiden), prothrombin G20210A mutation, methylenetetrahydrofolate reductase (MTHFR) gene C677T & A1298C mutations and plasminogen activator inhibitor-1 (PAI1) gene 5G/4G & 4G/4G polymorphisms. The results were compared with 44 controls with known predisposing factors (including history of thrombosis, atherosclerosis, hypertension, chronic renal insufficiency, diabetes mellitus, irritable bowel syndrome, chronic constipation, history of abdominal aorta aneurysm, history of schock and autoimmune disease) but no evidence of IC. Results: Low levels of PC and AT (p= .064 & p= .022, respectively), low levels of APCR (normal: >2, p = .008) and high levels of fibrinogen (p= .0005) were recorded in IC group. Homozygotes for MTHFR A1298C & C677T mutations tended to be more in the group with IC (χ2(2)= 5.582, p = .061 & χ2(2)= 1.291, p= .525, respectively). Furthermore, the prevalences of 5G/4G & 4G/4G polymorphisms were elevated in the patients group (χ2(2)= 6.973, p = .031), while the incidence of LA positives was higher in the same group (p = .037, FET). Multivariate analysis was performed to determine the effects of prothrombotic factors in IC. 5G/4G polymorphism of PAI-1 gene (OR 12.29; 95% CI 2.2667.00), APCR (OR .089; 95% CI 0.011-0.699) and fibrinogen (OR 1.013; 95% CI 1.0031.023) were determined as predictors of IC. (FET: Fischer's Exact Test, OR: Odds ratio, CI: Confidence intervals). Conclusions: This study suggests that hypercoagulability, hereditary or acquired, plays an essential role in the manifestation of IC.

Isolated cecal necrosis: our surgical experience and a review of the literature.

Isolated cecal necrosis is a rare cause of ischemic colitis. Ischemic colitis is further divided into two groups: occlusive mesenteric ischemia and non-occlusive mesenteric ischemia. The aim of this study was to investigate the cause of isolated cecal necrosis. We operated on 3 male and 3 female patients with a mean age of 60.3±18.7 (38-85) years with a preliminary diagnosis of acute appendicitis between 2007 and 2012. Four of these patients were on hemodialysis, 1 patient had an aortofemoral bypass, and 1 patient had coronary artery disease with atrial fibrillation. The diagnosis was made intraoperatively in all cases. Five patients died postoperatively. One patient survived. In the case of right lower quadrant pain, the possibility of isolated cecal necrosis should be kept in mind, especially in patients on hemodialysis, elderly patients with diabetes, and heart disease; surgical strategies should be planned accordingly, and it should be understood that a high mortality rate will be inevitable.

Sumatriptan-Associated Ischemic Colitis: Case report and Review of the Literature and FAERS

Ischemic colitis (IC) is being increasingly recognized, although specific etiological causes are observed in a minority of patients. While several drugs have been associated with IC, most remain anecdotal reports. We recently treated a patient with IC thought to be related to sumatriptan for migraines, and performed a literature review along with a review of the FDA Adverse Event Reporting System (FAERS) database to identify additional cases. A MEDLINE/PubMed literature review was conducted using standard IC search terms to identify published cases of sumatriptan and other related "triptan" drug causes of IC. In addition, through a Freedom of Information Act request, we reviewed the adverse gastrointestinal events linked to sumatriptan contained in the FAERS database for the 5-year period 12 March 2008-11 March 2013, in order to determine whether unpublished cases might exist. Our case of IC was analyzed using a causality assessment tool initially developed for use in cases of alosetron (a 5-HT3 receptor antagonist)-related IC. Five published reports (containing a total of seven patients) describing sumatriptan-associated IC in the English language literature were found and reviewed. Another four published reports of related 5-HT1 receptor agonists causing IC (razitriptan n=1 and naratriptan n=3) were also analyzed. Among spontaneous reports of possible IC contained in the FAERS database for sumatriptan, there were 19 adverse events coded as "ischemic colitis" and another six coded as "intestinal ischemia" over a 5-year period ending March 2013, but clinical details were lacking. Similarly, five reports of possible IC from FAERS were mentioned in an earlier published report from the late 1990s. All of the published case reports of sumatriptan and related drugs were deemed to have the classic clinical findings and all recovered. There was one instance of possible recurrent IC symptoms in one patient re-exposed to sumatriptan, but not in another. We found that the IC scoring system developed for alosetron was applicable in our sumatriptan case. Among drug-related causes of IC, sumatriptan joins a growing list of agents with literature reports supported by the finding of suspected cases of IC in the FAERS database. However, the true incidence of IC due to sumatriptan, as well as other causes, cannot be accurately determined because of the likelihood of under-reporting. The structured IC scoring system appears to be applicable for drug-related as well as other etiological causes of IC.

A Case of Oral-contraceptive Related Ischemic Colitis in Young Woman.

Ischemic colitis is generally considered a disease of the elderly. The causes of ischemic colitis include low-flow states due to cardiac dysfunction or hypovolemia and certain medications including estrogen. Here we report a case of ischemic colitis in a 26-year-old woman. She had no specific medical history except taking oral-contraceptives for a long time. The mechanism of estrogen-induced ischemic colitis is not clearly understood. But we recommend that oral-contraceptives should be considered as a cause of ischemic colitis in young women.

Colitis isquémica inducida por cocaína en un paciente de riesgo, tratada de forma conservadora

Drug consumption is among the non-occlusive causes of ischemic colitis. We report a case of cocaine-induced ischemic colitis in a 34-year-old man who had undergone sigmoid resection and loop colostomy due to abdominal-pelvic injury 3 months previously. The patient presented with abdominal pain associated with diarrhea and slight transient fever of doubtful etiology and reported intranasal cocaine consumption. He was hemodynamically stable and showed no peritoneal irritation. Traces of blood were found in the colostomy bag. Colonoscopy showed ulcers and necrosis proximal to the stoma. Computed tomography angiography scan showed no abnormalities except filiform inferior mesenteric artery. The symptoms were self-limiting and the patient was discharged 3 days after admission. Subsequently the colostomy was closed without complications. A high degree of suspicion is required in young patients with abdominal pain not identified by conventional methods and a recent history of drug consumption.

NO-Xplode: A Case of Supplement-Associated Ischemic Colitis

The most common cause of ischemic colitis (IC) is a sudden and transient reduction in splanchnic perfusion. In the younger population, medications are an increasingly recognized cause of ischemic bowel disease. Over-the-counter supplements may also lead to the development of ischemic colitis through similar effects. We present a case of ischemic colitis in a 42-year-old active duty service member after using the performance-enhancing supplement, NO-Xplode. In this report, we review the pharmacology of this supplement and its proposed mechanism of injury.

A rare cause of Ischemic colitis and review of literature.

A rare cause of Ischemic colitis and review of literature.

Gastrointestinal: Ischemic colitis with thrombosis of the inferior mesenteric vein

What is the cause of ischemic colitis? The obvious answer is a reduction in the blood supply to the colon. But does this occur because of hypotension, arterial disease, arterial emboli, vasculitis, small vessel disease or venous thrombosis? In a minority of patients, ischemic colitis is clearly related to hypotension associated with cardiac disease, serious illness or recent surgery. In most patients however, the cause remains unclear even after extensive investigations including mesenteric angiography. In the patient described below, ischemic colitis was attributed to thrombosis in a segmental branch of the inferior mesenteric vein. This may be the first reported case of reversible mesenteric venous thrombosis that has been confirmed by imaging techniques. The patient was a 50-year-old woman who was referred for evaluation because of lower abdominal pain and rectal bleeding for 12 hours. Prior to the development of symptoms, she described intermittent constipation and had previously had a hysterectomy. On examination, there was mild tenderness on palpation over the lower abdomen. Blood tests revealed a mild elevation of her white cell count and C-reactive protein. Plain X-rays of her abdomen were normal but an abdominal ultrasound study revealed segmental thickening of the wall of the sigmoid colon. A contrast-enhanced computed tomography (CT) scan on the second day after admission showed a tubular defect of low attenuation within the sigmoid vein (Fig. 1, arrow). At colonoscopy, on the fourth day after admission, the sigmoid colon was abnormal with mucosal edema, patchy erythema, contact bleeding, nodularity and minor ulceration (Fig. 2). The appearance was typical of ischemic colitis and this was supported by histological evaluation of sigmoid biopsies. Her symptoms resolved over 3 days and follow-up investigations including a barium enema study, repeat colonoscopy and a repeat CT scan were normal apart from linear scars in the sigmoid colon at colonoscopy. Extensive investigations for a hypercoagulable state were undertaken but no abnormalities were detected. Serological studies raised the possibility of a connective tissue disorder but there were no clinical features and the patient was well on follow-up after 15 months.

Nichtokklusive Ischämie (NOI) des rechtsseitigen Kolons

Nonocclusive disease (NOD) is known to be a common cause of ischemic colitis, which is frequently underestimated. A computer-assisted search of radiological reports at our institute over a period of 18 months, describing ischemic colitis of the ascending colon with an unimpaired perfusion of the superior mesenteric artery, was performed. A retrospective analysis of the clinical and radiological data of 14 patients was performed. In ten cases colonic ischemia was confirmed clinically or intraoperatively. Most of our patients needed intravenous catecholamines due to severe hypotension. However, no significant radiographic predictors could be identified. Awareness of NOD seems to be crucial. Especially in cases of acute abdominal pain associated with severe hypotension, renal insufficiency, or pancreatitis, one should include NOD as a differential diagnosis at an early stage.