Ischemic colitis. Case report

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.