Acute ischemic colitis - moderate form – Example
This 68-year-old male presents with an eight-day history of diffuse abdominal pain and some diarrhea. After three days, he noticed some blood in the stool. Microbiological stool examination failed to show evidence of infection. At hospital admission six days following onset of symptoms, the abdomen was still soft, but painful to pressure throughout the left upper and lower quadrants. At ultrasound, the wall of the left-sided colon was thickened. Colonoscopy was performed eight days after onset of symptoms under suspicion of ulcerative colitis.
The video begins in the right transverse colon. The more proximal bowel segments are unremarkable. Mucosa changes characterized by flat ulcerations, hematomas and edema began in the right half of the transverse colon. In the vicinity of the splenic flexure and in the descending colon there are hematomas of different ages. Fresh red hematomas are scattered among dark to black hematomas. The mucosa is vulnerable with spontaneous bleeding and copious exudate. In the sigmoid colon, these changes transition to normal mucosa. The transition is not abrupt and there are more distal islands of flat ulceration. Vascular structure can again be recognized.
The mucosa shows all the typical changes of ischemic colitis that started a few days earlier. One recognizes both fresh, bright red hematomas and ulcerations and older areas of bleeding. There are only a few areas of severe edema. As in many cases of ischemic colitis, the transition to normal mucosa is not quite abrupt and there are distal areas with islands of flat necroses.