Ischemic pancolitis: A rare presentation of a relatively common disease

Abstract

Background: Ischemic colitis represents the most common form of gastrointestinal ischemia. Ischemic colitis may be classified into gangrenous and non gangrenous forms. High morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis. Patient-Methods: A 78-year-old man was admitted to our department with severe, generalized, abdominal pain, diarrhea and vomiting.A flexible sigmoidoscopy, demonstrated patchy areas of mucosal necrosis while the entire mucosa appeared edematous,cyanotic, dusky and black with pseudopolyps and subepithelialhemorrhage. A sub-total colectomy was performed with a colostomy of ascending colon and rectal preservation.The patient recovered uneventfully and the histopathology documented the diagnosis of extensive ischemia. Conclusion:Fulminant universal colitis is a rare form of colon ischemia.Colonoscopy and aggressive treatment with surgical resection of the affected segment should be considered early to minimize adverse outcomes.Perioperative colonoscopy is the procedure of choice to establish the extent of ischemic damage and determine the extent of resection. Ischemic colitis represents the most common form of gastrointestinal ischemia.Colonic blood supply is lower than that of any other intestinal segment. It decreases during strenuous physical activities precipitating in colonic ischemia in the setting of pre-existing mesenteric microvascular atherosclerosis.1,2 It usually occurs in the elderly with concomitant illnesses such as shock, colon cancer or after surgical intervention in the aorta and the mesenteric vessels. It might also spontaneously appear in apparently healthy individuals. Inherited and acquired risk factors have been suggested to play an important role in the pathogenesis of ischemic colitis.3,4 Ischemic colitis may be classified into gangrenous and non gangrenous forms. The latter can also be subdivided into transient and chronic forms. Therapy and outcome varies depending on the severity of the disease.