Acute ischemic colitis - mild form - Example 1

Author:

Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.

Clinical presentation

Two days prior to inpatient admission, this 70-year-old male suddenly experienced cramping abdominal pain. Shortly thereafter, he noted passage of gas and bloody stool. He had no prior history of bowel disease. At the time of admission, the abdomen was soft and not painful to pressure. The CRP was slightly elevated.

Videoclip

The video begins in the descending colon. The more proximal colonic segments were unremarkable. The pathological changes in the mucosa begin in the lower descending colon with edematous, swollen mucosa and numerous areas of erythema. At some place, the mucosa resembles that seen in portal gastropathy. There then follows an area with numerous erosive changes and flat ulcerations. Fresh bleeding can be seen at some places. In the distal sigmoid colon, there is a sharp demarcation to normal mucosa.

Commentary

Histological examination revealed segmental hemorrhagic and erosive ischemic colitis with evidence of circulatory disturbances. More severe inflammatory infiltrates were not observed. These represent early changes in ischemic colitis. At a follow-up endoscopy six weeks later, no pathological changes were observed. In particular, there were no ulcerations and no signs of connective tissue stenoses.

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