Stercoral colitis complicated with ischemic colitis: a double-edge sword.

BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis. CASE PRESENTATION: An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia. CONCLUSION: Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.

Phlebosclerotic colitis: case report and literature review focused on the radiologic findings in relation to the intake period of toxic material.

Phlebosclerotic colitis (PC) is a rare disease entity of intestinal ischemia characterized by calcification at the right hemicolon and is predominant in Asian populations. We present a 57-year-old Korean patient who was an Oriental medicine practitioner himself and had been taking herbal medicine for decades. We reviewed previous literature on similar cases and analyzed radiologic features of PC in relation to the intake period of toxic material and extent of disease.

Usefulness of CT in patients with ischemic colitis proximal to colonic cancer.

OBJECTIVE: The purpose of this study was to assess the usefulness of CT scans for distinguishing ischemic from tumoral segments in patients with colonic carcinoma complicated by proximal bowel ischemia. MATERIALS AND METHODS: CT scans of 20 patients with ischemic colitis proximal to obstructing colonic carcinoma were reviewed retrospectively. The concomitant presence of ischemia was proven on pathologic examinations in 12 patients and on barium enema studies in the remaining eight patients. CT scans were analyzed for the involved site and length, bowel wall thickness, enhancing pattern of both tumoral and ischemic segments, and changes in the pericolic space. The results of tumor staging on CT scans were compared with those of pathologic findings. RESULTS: Distinction of ischemic from tumoral segments could be made on CT in 15 (75%) of the 20 patients. Of the 20 patients, 18 had ischemic segments contiguously proximal to the tumoral segment, and the remaining two patients had a skipped zone with intervening normal mucosa. Tumoral segments were irregularly thickened in most patients. Maximum thickness ranged from 0.8 to 4.5 cm (mean, 2.0 cm). Most often the ischemic segment was concentrically and smoothly thickened, ranging from 0.6 to 1.5 cm (mean, 1.0 cm). The tumoral segments enhanced heterogeneously in 12 patients and enhanced homogeneously in the remaining eight, whereas ischemic segments enhanced homogeneously in 14 (70%) patients and heterogeneously in six. On CT scans, we saw the target or double halo sign in four (20%) patients. Pericolic vascular engorgement was 19 patients, two of whom were overstaged because pericolic vascular engorgement was interpreted as tumor infiltration. CONCLUSION: Although CT findings are not specific for certain groups of patients, they are often helpful in distinguishing tumoral from ischemic segments in patients with ischemic colitis proximal to colonic carcinoma. An understanding of this pathologic entity may increase the accuracy of CT for staging colonic carcinoma.

Clinical features in young adult patients with ischaemic colitis.

The clinical, radiographic and endoscopic findings in 16 patients with ischaemic colitis, all of whom were < 45 years of age, were analysed. The clinical features were characterized by an acute onset of abdominal pain and rectal bleeding, and persistent constipation prior to the onset of symptoms. Twelve of the 16 patients did not have any known predisposing factors. Barium enema examination and colonoscopy revealed longitudinal ulcers and oedema of the left side of the colon of these patients. These features were then compared with those found in patients with ischaemic colitis, who were > 70 years of age. Although the clinical symptoms, the site of involvement and the initial radiographic or endoscopic findings were similar between the two groups, the transient form of ischaemic colitis and constipation prior to the onset of symptoms were more frequently present in the young patients than in the old patients. These findings suggest that ischaemic colitis, which is not a rare condition even in young adults, is less severe in young patients than in old patients, and that constipation may be related to the pathogenesis of this disease in young adults.

Ischaemic colitis in association with sigmoid carcinoma: a report of two cases.

The association of ischaemic colitis with a distal obstructing carcinoma is described in two patients. When a segment of colonic ischaemia is demonstrated on barium enema, it is important to consider an association with a distal tumour.