A case of constrictive ischemic colitis in the right side of the transverse colon

Abstract

A 69-year-old male was admitted to the other hospital due to hematochezia and hypotension during hemodialysis. He had a history of hypertension, diabetes mellitus, chronic renal failure and cardiac infarction. Abdominal CT scan showed wall thickening of the right side of the transverse colon. Colonoscopic findings showed circumferential ulceration with stenosis in this region, and thus the patient was transferred to our hospital. He had anemia (Hb 5.7 g/dl) and underwent a blood transfusion. Serum albumin was 2.9 g/dl, serum CRP was 7.8 mg/dl and a QFT test was negative. Colonoscopic findings confirmed the circumferential ulceration with stenosis in the right side of the transverse colon and biopsy specimens taken showed infiltration of inflammatory cells. On the 22nd day after admittance, follow-up colonoscopy showed healing of ulceration with worsening of the stenosis, and fluoroscopic findings showed smooth stenosis 3 cm in length. The patient was diagnosed with constrictive ischemic colitis. Food intake began, and as the patient no longer had symptoms he was discharged on the 25th day. Eight months later, the patient still had no symptoms, colonoscopic findings showed scar formation with stenosis, and fluoroscopic findings showed no change. Cases of constrictive ischemic colitis in the right side of the transverse colon sometimes develop ileus and require surgery. We report here a rare case that responded to conservative therapy.