Re: Ischemic Colitis

Posted By HFHSM.D.-ym on October 21, 1998 at 09:21:39:

In Reply to: Ischemic Colitis posted by Alan on October 20, 1998 at 22:02:39:






I am a 37 year old male who has just had a third occurence of what has been diagnosed as ischemic colitis.
In each case, I have been awakened from my sleep with severe pain in the lower left quadrant.  The severe pain lasts up to one hour during which time I am unable to have a bowel movement.  The pain subsides some with the onset of explosive diareaha but becomes more severe with each following episode. After two to three hours a bloody mucous appears and continues to become more and more prevalent with each bowel movement.
These 3 occurences have taken place 9/95, 8/97, and 9/98; and each occurence seems to be worse than the one it preceded.  In every occurence the same section of the colon has been affected(approx. 50 cm. long).  An arteriogram was done the last two times and both doctors have ruled out a problem with the vascular supply.  Surgery was given to me as an option with the second occurence, but I elected not to have a resection because I was given no guarantees as the specific cause could not be found.
I am aware that this diagnosis is highly unusual for someone my age, but I have been advised by a second physician that the diagnosis is correct after a thorough review of past medical history and more tests.  I have been referred to a surgeon with the only explanation that this could be a intussusception or volvulus.  
What questions should I ask?  Is surgery the best or only option?  I need resolution for my sanity!  Thaks, Alan
Dear Alan,
As you mentioned the diagnosis of ischemic colitis is more common in elderly patients with cardiovascular disease. However,
there are two particular diagnoses that come to mind that can mimic ischemic colitis and occur in younger patients. One is a
bacterial infection with an organism called enterohemorrhagic E. coli or E.coli 0H157 and the other is inflammatory bowel
disease (either Crohn's disease or ulcerative colitis). You should definitely have stool cultures sent to look for infectious
organisms. Enterohemorrhagic E. coli needs to be specifically looked for and the lab should be alerted to this fact when the
specimen is sent. If the diagnosis is indeed ischemic colitis, most cases resolve on their own, however, one can get a chronic
colitis or a stricture (narrowing of the colon). In cases where a complication (such as colitis or stricture) occurs the only
available treatment is surgical resection of affected segments. It would be important to exclude underlying heart disease in
patients with colonic ischemia. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or
consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physician's Office and make an
appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: ischemic colitis, differential diagnosis, treatment