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.