Arterial embolization during percutaneous vertebroplasty resulting in bilateral renal infarcts and ischemic colitis.

This case report documents an arterial embolic event that occurred during vertebroplasty for a pathological compression fracture of T12 in a 54-year-old female with known metastatic breast carcinoma. A CT angiogram performed after the procedure demonstrated cement migration into the aorta, both kidneys, and the inferior mesenteric artery and its branches, with ischemic colitis involving the descending colon and sigmoid colon. A CT scan 4 months post-procedure demonstrated resolution of the colitis. Neovascularity and cortical destruction in malignant bone lesions are thought to contribute to arterial cement leak.

Pneumatosis intestinalis: a rare endoscopic feature of colonic ischemia.

A 71-year-old male was admitted on intensive care unit after endovascular aneurysm repair of ruptured infrarenal abdominal aortic aneurysm. 2 weeks later, he had multiple episodes of bloody diarrhea. Colonoscopy revealed diffuse dusky mucosal coloration with loss of vasculature pattern, diseased haustrations, and diffuse areas of pneumatosis, suggestive of severe colonic ischemia.

Development and validation of a composite score to predict severe forms of ischemic colitis.

OBJECTIVE: To develop a simple scoring system in order to predict the risk of severe (death and/or surgery) ischemic colitis METHODS: In this retrospective study, 205 patients diagnosed with ischemic colitis in a tertiary hospital were consecutively included over a 6-year period. The study sample was sequentially divided into a training cohort (n = 103) and a validation cohort (n = 102). In the training cohort, multivariable analysis was used to identify clinical, biological, and CT variables associated with poor outcome and to build a risk scoring system. The discriminative ability of the score (sensitivity, specificity, positive predictive value, negative predictive value) was estimated in the two cohorts to externally validate the score, and a receiver operating characteristic curve was established to estimate the area under the curve of the score. Bootstrapping was used to validate the score internally. RESULTS: In the training cohort, four independent variables were associated with unfavorable outcome: hemodynamic instability (2 pts), involvement of the small bowel (1 pt), paper-thin wall pattern (3 pts), no stratified enhancement pattern (1 pt). The score was used to categorize patients into low risk (score: 0, 1), high risk (score: 2-3), and very high risk (score: 4-7) groups with sensitivity and specificity of 97% and 67%, respectively, and a good discriminating capability, with a C-statistic of 0.94. Internal and external validation showed good discrimination capability (C-statistics of 0.9 and 0.84, respectively). CONCLUSION: A simple risk score can stratify patients into three distinct prognosis groups, which can optimize patient management. CLINICAL TRIAL NUMBER: NCT04662268 KEY POINTS: • Simple scoring system predicting the risk of severe ischemic colitis • First study to include CT findings to the clinical and biological data used to determine a severity score.

NSAID-induced ischemic colitis.

We present the case of a 38-year-old man with no previous medical history who went to the emergency department due to abdominal pain and diarrheal stools with blood of 24 hours of evolution. The patient reports consumption of anti-inflammatories the previous days due to back pain.

Colonoscopy-related colonic ischemia.

Colonoscopy is a risk factor for colon ischemia. The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs; the etiology of colon ischemia after colonoscopy is multifactorial. The causative mechanisms include splanchnic circulation impairment, bowel preparation, drugs used for sedation, bowel wall ischemia due to insufflation/barotrauma, and introduction of the endoscope. Gastroenterologists must be aware of this condition and its risk factors for risk minimization, early diagnosis, and proper treatment.

A rare case of ulcerative colitis in a patient who developed acute ischemic colitis associated with Takayasu arteritis.

Intestinal ischemia is a rare complication of Takayasu arteritis (TAK), which often requires colectomy. We report the case of a 27 year-old man with ulcerative colitis (UC), who was admitted to our hospital due to abdominal pain. Computed tomography revealed an edematous wall of the ascending colon with ascites and a thickened aortic wall with mild stenosis of the superior mesenteric artery (SMA), suggesting large vessel vasculitis, especially TAK. Colonoscopy revealed acute ischemic colitis associated with mild stenosis of the SMA caused by TAK, but there was no worsening of UC. The patient was successfully treated with conservative therapy.

Inferior mesenteric arteriovenous fistula with colonic ischemia: a case report and review of the literature.

Inferior mesenteric arteriovenous fistula is a rare abnormal high flow communication with only 40 primary and secondary cases reported in literature. Shunting of arterial flow through the inferior mesenteric vein to the portal system can cause a variety of nonspecific clinical signs and symptoms usually associated with the diagnosis of arteriovenous malformation. Symptom intensities are flow-dependent and can range from minimal abdominal symptoms to severe heart failure due to left to right shunt. We report the case of a 72-year-old man without past history of abdominal surgery or trauma who was referred to our department for a 2-month history of intermittent diarrhea and abdominal pain caused by an arteriovenous fistula involving the left colic artery and the inferior mesenteric vein. A progressive and spontaneous improvement of symptoms and a control CT scan that confirmed the reduction of venous vascular engorgement and regression of parietal thickening of the left and sigmoid colon permitted a non-operative management.Inferior mesenteric arteriovenous fistula can be a rare cause of ischemic colitis and, if necessary, an appropriate treatment based on high clinical suspicion can reduce the risk of complications related to a missed diagnosis.

[A case of circumferential rectal wall thickening caused by prostate cancer invasion concomitant with ischemic colitis].

A man in his 70s presented to Kyojinkai Komatsu Hospital with lower left abdominal pain and hematochezia after repeated use of laxatives. Computed tomography (CT) revealed continuous bowel wall thickening from the descending colon to the rectum. The symptoms and CT findings were consistent with ischemic colitis. The patient's condition improved with conservative treatment. However, the patient was reexamined 3 months later because complaints of constipation and voiding difficulty continued. Colonoscopic findings revealed rectal stenosis and reddish edematous mucosa with nodular alterations. Although CT showed that the abnormality in the descending and sigmoid colon had resolved, the wall thickening and annular stricture of the rectum persisted. The prostate was irregularly enlarged, encircling and compressing the rectum. Rectal biopsy results did not reveal malignancy. However, moderately to poorly differentiated adenocarcinoma was detected by prostate biopsy. Consequently, the patient was diagnosed with prostate cancer with rectal involvement. The rectal wall thickening and the symptoms improved following hormone therapy. Thus, concomitant prostate cancer invasion should be considered when CT reveals continuous colon wall thickening up to the rectum in a patient suspected of ischemic colitis.

Ischemic colitis and short bowel disease due to choronavirus disease 2019 (COVID 19).

COVID-19 has spread worldwide, with more than 2.5 million cases and over 80,000 deaths reported by the end of April 2020. In addition to pulmonary symptoms, gastrointestinal symptoms have been increasingly recognized as part of the disease spectrum. COVID-19-associated coagulopathy has recently emerged as a major component of the disease, leading to high morbidity and mortality. Ischemic colitis has been reported to be associated with a hypercoagulable state, However few cases have been reported of COVID-19 associated with ischemic colitis. We would like to report a case of a 53 year old man with medical history of type 2 diabetes, and hypercholesterolemia, with ishchemic colitis as first manifestation of infection of COVID 19.