A Case of Constrictive Ischemic Colitis Necessitating a Surgery Due to Delayed Cicatricial Stenosis

Abstract

Ischemic colitis, often idiopathic, is a disease of the digestive system commonly found in patients with symptoms of abdominal pain and/or melena. In most cases, however, ischemic colitis is treated with conservative treatment and only in rare cases requires surgery. This is a case report of a patient who was diagnosed with ischemic colitis and later was required surgery due to advanced cicatricial stenosis. Patient is a 75-year-old female who had been experiencing abdominal pain followed by diarrhea and melena from several days before. Making a visit to a local clinic, she was recommended and admitted to our hospital for further diagnosis as well as adequate treatment. After conducting a colonoscopy, a lesion consisting of a 5 centimeter-long submucosal bleeding around the entire circumference of the descending colon, closer to the anus, was found. Under a pre-condition of fasting, the patient was given medical treatment via central venous hyperalimentation. In a later colonoscopy, only a mild case of cicatricial stenosis was found. However, even after resuming oral intake, there were no recurrences of symptoms such as abdominal pain, melena or ileus. On the 14th day of illness, patient was discharged from the hospital. Nevertheless, after some time of ambulatory care visits, on the 54th day of illness, the patient was again hospitalized for a thorough reexamination of the narrow pass. After conducting a colonoscopy, it was found that the lesioned part had generated a more severe, stiffer cicatricial stenosis. After checking with family members about patient's progress, a decline in amount of ingestion was revealed which, as a result, necessitated surgery on the patient. Postoperative course was uneventful, and the patient was able to leave the hospital rather quickly, 12 days after the surgery. Ten to 15 % of ischemic colitis cases are regarded constrictive. Most cases are ischemic changes on the outside layer of the mucosa. However, in case of significant ischemic change, the surface layer of the mucous membrane can be replaced with a fibrous structure which results in the occurrence of delayed cicatricial stenosis. In this case, possibilities of significant ischemia at first endoscopy, as well as possibilities of delayed changes at the following endoscopy, should have been considered. Patient's refusal to undergo surgery caused a delay in finding ileus of the intestine. As far as symptoms of significant ischemia and constriction were found, swift reexamination with awareness of possibilities of surgery should have taken place.