Acute ischemic colitis - severe form - Example 1
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
This 85-year-old woman was admitted with a history of abdominal pain that had started a few days earlier, together with peranal passage of blood and mental status change. Suspicion of ischemic colitis led to colonoscopy, after which the patient underwent surgery with placement of a transversostomy. Ischemic colitis was confirmed at surgery. There was, however, no visible transmural ischemia.
The subsequent histological examination of colonoscopy specimens confirmed the diagnosis of ischemic colitis.
Colonoscopy was possible up to the rectosigmoid junction. Further advance of the instrument was not attempted. The mucosa up to the anal canal was ischemically changed and was dark-livid in color, edematous and ulcerous.
Colonoscopy in the presence of such changes is performed at great risk of perforation. Hence, one must work with great caution and with little insuflation of air. The instrument should never be forcefully advanced. The extent of the ischemia can in such cases be determined by ultrasound.