A case of ischemic colitis caused by picosulfate administered for bowel preparation prior to colonoscopy

Abstract

A 50-year-old woman with constipation, high blood pressure, and a history of open abdominal surgery for myoma of the uterus was referred to our hospital for colonoscopy because of a positive fecal occult blood test during a medical checkup. The patient was administered 10 ml of picosulfate at 9 PM. Approximately 8 hours later, she developed vomiting, melena, and severe lower abdominal pain. Colonoscopy revealed reddening, edema, longitudinal erosions and easy bleeding in the sigmoid colon. The patient was diagnosed as having ischemic colitis and hospitalized. With conservative treatment, she recovered within 5 days and was discharged. Six weeks later, she underwent a colonoscopy without prior administration of picosulfate, and the findings revealed complete recovery.
Risk factors for ischemic colitis include high intracolonic pressure, rapid peristalsis, constipation, adhesions, postoperative state, and high blood pressure, some of which were present in this patient. Prior administration of a mild laxative instead of picosulfate should be considered for patients with such risk factors.