Abstract:
Ischemic colitis is very rare in Romania; there are difficulties in diagnosis and surgical
treatment, and the late diagnosis in advanced cases causes a high rate of mortality. Reduced blood
flow in the large bowel may lead to different pathologies from complete reversible injuries to total
ischemic necrosis of the large bowel. Elder patients, atherosclerosis, inferior mesenteric artery
thrombosis, cardiac arrhythmias, aneurisms of the abdominal aorta etc predispose to ischemic colitis.
Case: A 73-year old woman presented with melena, diffuse abdominal pain, nausea and vomiting.
Laboratory evaluation revealed a WBC of 20,900/ mm3, glicaemia of 194mg/dl, without other
abnormalities. Plain abdominal radiography and abdominal ultrasound were normal. Emergency
exploratory laparotomy revealed a rubbery hard colon, without the normal aspect of haustrations,
feeling like a parenchimatous organ, from the left colic angle to the recto-sigmoid jonction. The
dissection of the origin of the inferior mezenteric artery proved its complete thrombosis. There was
performed a left hemicolectomy with terminal colostomy on the transverse colon. Postoperative
course was uneventful. Nine months after the first operation, the continuity of the digestive tract was
restored by a colo-rectal anastomosis, without any problems. Conclusions: We present a rare case of
abdominal surgery in our country that needs to be identified early in order to be treated succesfully. It is very important to include ischemic colitis in the differential diagnossis of the abdominal pain
syndrome in elder pacients and also in surgeries was we suspect the necrossis of some parts of the
large bowel. Not knowing the gravity of the clinical signs and late diagnosis may lead to masive
bacterial invasion, toxic ischemic products into the blood stream that eventualy lead to a severe septic
shock.