Acute ischemic colitis - severe form - Example 2
This 56-year-old male had undergone a quadruple aortocoronary bypass graft four weeks earlier. The patient also exhibited absolute arrhythmia. Thereafter, the patient developed renal insufficiency requiring dialysis, worsening of the synthetic function of the liver and bloody diarrhea, during the work-up of which the patient underwent colonoscopy. There was no evidence of Clostridium difficile (toxin or organism) in the stool. The patient died ten days later secondary to multiorgan failure.
The entire colon was affected to varying extent in this severely ill patient. Withdrawal of the instrument begins in the ascending colon and initially shows mucosa with increased vascular structure, splotchy erythema and small ulcerations. There follow two relatively sharply demarcated areas of highly abnormal mucosa. There is high-grade edema, dark red to blue discoloration of the mucosa and larger areas with necrotic mucosa. Between these two areas, there is mucosa with increased vascular structure, erythema, small hematomas and individual erosions. Further distalwards, there is extensive edema, individual ulcerations, erosions and hematomas. The changes are of reduced severity as more distal areas of the colon are reached. In the distal sigmoid colon, the mucosa is essentially normal.
These findings are typical for ischemia in the colon with high-grade segmental changes. The patient’s prior cardiac damage formed the basis for progressing circulatory failure.