2014 Volume 56 Issue 10 Pages 3631-3638
Herein, we describe a rare case of transient-type ischemic enteritis, in which the lesions were endoscopically observed during the acute and healing phases.
A 91-year-old woman was transported to our hospital by ambulance because of sudden onset of hematochezia and lower abdominal pain. Abdominal computed tomography showed wall thickening of the distal ileum. Colonoscopy was performed 18 h after onset of symptoms, and revealed mucosal edema and purple protruding lesions in a continuous, circumferentially scattered pattern 10 cm behind the ileocecal valve. The protruding lesions were covered with a pseudomembrane and were suggestive of submucosal hematoma. Fluoroscopic examination of the small intestine with water-soluble contrast agent revealed approximately 20-cm long, thumbprint-shaped projections. After antibiotic administration and intravenous infusion following fasting, her symptoms gradually improved. Colonoscopy performed on hospitalization day 8 showed a circumferential ulcer with slough, and the endoscope could not be inserted because of lumen narrowing in the distal ileum. An oral diet was started, and no signs of bowel obstruction were noted ; therefore, the patient was discharged on day 14. Colonoscopy performed 8 months after disease onset showed an ulcer scar, but lumen narrowing in the distal ileum was not observed. Based on the clinical course and examination results, the patient was diagnosed with transient-type ischemic enteritis.
The difference in the endoscopic findings at admission and on day 8 in this case suggests that the endoscopic appearance may be different before and 48 h after disease onset, as is observed in ischemic colitis.
Lumen narrowing may not be observed at disease onset, but may develop 8-9 days after onset, regardless of whether the ischemic enteritis is of the transient type or stricture type.
