Acute ischemic colitis with hematochezia related to baloxavir marboxil treatment for influenza A

Oseltamivir, an established oral anti-influenza medication, increases the risk of ischemic colitis. Baloxavir marboxil is a novel oral anti-influenza medication, and few studies have evaluated its potential side effects, including ischemic colitis. Moreover, as influenza A can also induce ischemic colitis, drug-induced colitis associated with anti-influenza medication is not clearly understood. In this report, we describe the case of a 62-year-old Japanese woman who developed acute ischemic colitis after taking baloxavir for influenza A. The day after taking baloxavir (day 2), the patient experienced abdominal pain, diarrhea, and nausea. On day 3, she had developed hematochezia and decided to visit our hospital. Upon presentation, inflammation of the descending and sigmoid colon was detected by abdominal echography and computed tomography. Fluid replacement therapy and dietary restrictions were initiated. On day 4, the inflammation of the descending colon and marked intestinal edema were confirmed by colonoscopy. She was clinically diagnosed with ischemic colitis, from which she recovered completely by day 9. This case suggests that patients taking baloxavir may be at risk of developing ischemic colitis with hematochezia and underscores the need to further study the induction of this condition by commonly used oral anti-influenza agents.     

Probable ischemic colitis caused by pseudoephedrine with tramadol as a possible contributing factor

OBJECTIVE: To report a case of acute self-limiting ischemic colitis in a patient who was self-medicating with a proprietary over-the-counter oral decongestant containing pseudoephedrine. CASE SUMMARY: A 46-year-old white man developed clinical, endoscopic, and histologic features of acute ischemic colitis after taking a proprietary oral decongestant containing pseudoephedrine 240 mg/day for one week. The total daily dose was at the upper limit of recommended doses for pseudoephedrine (as a single drug or in combination products). The patient was also taking tramadol 150 mg/day for chronic back pain. He made a complete recovery. There were no other explanations for the episode of ischemic colitis. DISCUSSION: An objective causality assessment based on the Naranjo probability scale revealed pseudoephedrine to be a probable cause of ischemic colitis in our patient. Pseudoephedrine occasionally causes vascular insufficiency due to intense vasoconstriction, even at standard doses. Although our patient was not taking an excessive dose of pseudoephedrine, it is possible that the concurrent use of pseudoephedrine and tramadol may have increased adrenergic vasoconstriction, predisposing to ischemic colitis. CONCLUSIONS: Prolonged or intensive use of medications containing pseudoephedrine should be avoided, and the package information should contain advice that the medication should be ceased if abdominal pain or other ischemic symptoms occur.     

A Case of Oral-contraceptive Related Ischemic Colitis in Young Woman

Ischemic colitis is generally considered a disease of the elderly. The causes of ischemic colitis include low-flow states due to cardiac dysfunction or hypovolemia and certain medications including estrogen. Here we report a case of ischemic colitis in a 26-year-old woman. She had no specific medical history except taking oral-contraceptives for a long time. The mechanism of estrogen-induced ischemic colitis is not clearly understood. But we recommend that oral-contraceptives should be considered as a cause of ischemic colitis in young women.     

老年人缺血性结肠炎50例临床特点分析

目的探讨老年人缺血性结肠炎临床特点和易患因素。方法 64例缺血性结肠炎患者根据年龄分为老年组50例(年龄≥60岁)和对照组14例(年龄<60岁)。回顾分析临床资料,并进行组间比较。结果①多数患者表现为腹痛、便血、腹泻三联征,两组腹痛、血便、腹泻症状发生率比较无显著差异;②结肠镜下以黏膜充血、水肿、糜烂、溃疡等为主要表现,病变主要发生于左半结肠,两组间病变部位比较无显著差异;③缺血性结肠炎好发于老年患者,多伴有冠心病高血压、糖尿病等基础疾病,多数患者预后良好;④老年组患者的血红蛋白(Hb)、血清白蛋白(Alb)浓度低于对照组,差异有显著性(P<0.01),老年组C反应蛋白(CRP)水平高于对照组,差异有显著性(P<0.05)。结论老年缺血性结肠炎临床表现主要为腹痛、便血、腹泻;病变部位主要累及左半结肠。动脉粥样硬化相关性疾病是老年缺血性结肠炎的好发因素。贫血、低白蛋白血症是缺血性结肠炎重要的危险因素。CRP增高提示炎症反应也可能是老年人缺血性结肠炎的危险因素。     

Ischemic colitis revisited: a prospective study identifying hypercoagulability as a risk factor

BACKGROUND: Although causes for ischemic colitis have been identified, many cases are deemed idiopathic. Some reports suggest an association between ischemic colitis and coagulation disorders. Our purpose was to explore the relationship of ischemic colitis and clotting abnormalities. METHODS: Eighteen patients consented to undergo a hypercoagulability evaluation. Tests included protein C, protein S, activated protein C resistance, factor V Leiden, anticardiolipin antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, antithrombin III, anti-smooth muscle antibody, lupus anticoagulant panel, and prothrombin 20210G/A mutation (in women undergoing hormone replacement therapy). RESULTS: Five of 18 patients tested positive for coagulation abnormalities, including factor V and activated protein C resistance, protein S deficiency, prothrombin 20210G/A mutation, and anticardiolipin antibody. CONCLUSION: To our knowledge, this is the largest series of patients with ischemic colitis studied for coagulation defects in the United States. The prevalence of clotting disorders in our study (28%) was higher than that in the general population (8.4%). Coagulation disorders should be considered in some cases of ischemic colitis that are thought to be idiopathic.     

高压氧治疗缺血性结肠炎的疗效观察

目的：观察探讨高压氧治疗缺血性结肠炎的疗效。方法：入选67例缺血性结肠炎患者,将患者分为高压氧组（36例）和对照组（31例）,2组基础治疗相同。高压氧组在此基础上人院次日行高压氧治疗,比较研究两组患者结肠恢复的治愈率及总体有效率。结果：高压氧组和对照组总有效率分别为91．7％和67．7％,两组总有效率比较差异有统计学意义（P〈O．05）。结论：高压氧治疗缺血性结肠炎具有显著疗效。     

The endoscopic spectrum of colonic mucosal injury following aortic aneurysm resection

Ischemic colitis is a serious complication of aortic aneurysm resection. A knowledge of the endoscopic appearance and the clinical course of various forms of colonic mucosal injury is important for the clinician who has to decide which patient should be carefully monitored after aneurysm resection. This article reports on 48 patients with colonic mucosal injury, subdivided into non-specific lesions and ischemic colitis. Details are given of the endoscopic picture and the clinical course. It is concluded that only the gangrenous form of ischemic colitis is of clinical significance, and is related to bowel perforation and late stricture formation.     

Radiographic demonstration of longitudinal ulcers in patients with ulcerative colitis

During the past 10 years, 122 patients with ulcerative colitis were diagnosed by double-contrast barium enema and colonofiberscopy with endoscopic biopsy. Among them, five patients (4%) had longitudinal ulcers and eccentric deformities in the colon. Other radiologic findings included thumbprinting (two cases), sacculations (two cases), and inflammatory polyps (four cases). The possibility of the concomitance of ischemic colitis in cases of ulcerative colitis is discussed, due to their radiographic similarities.     

CT findings in runner’s colitis

A spectrum of lower gastrointestinal tract symptoms occurs in marathon runners. Although most symptoms are transient, reversible ischemic colitis is a rare complication that typically responds to supportive therapy. Because computed tomographic features have not been previously described to our knowledge, we describe abdominal computed tomographic manifestations of reversible ischemic colitis in three marathon runners. On computed tomography, reversible ischemic colitis involves the cecum, with varying involvement of the proximal colon.     

Diagnosis and differential diagnosis of colonic diverticulitis.

A patient over 40 years of age who complains of lower abdominal pain, constipation or diarrhea or both, and increased flatulence should be suspected of having diverticulosis. When pain becomes more severe and persistent, diverticulitis must be considered. Diagnosis depends on roentgen demonstration of the presence of diverticula. Sigmoidoscopy and barium enema study are essential to exclude coexisting disease but in diverticulitis may need to be postponed until severe local and systemic signs of inflammation have subsided. A number of diseases can simulate diverticulitis, and differential diagnosis may present considerable difficulty. Irritable colon syndrome and acute appendicitis may be indistinguishable clinically from diverticulitis. Differentiation from carcinoma is usually not difficult, but exclusion of coexistent carcinoma may be impossible except by resection. Ulcerative colitis is also easily distinguished except when, rarely, it coexists. Crohn's disease of the colon is less easily differentiated, especially in patients over 40, in whom the two diseases often coexist. Other colonic diseases, such as ischemic colitis, and pelvic inflammatory diseases usually show characteristic features which make them readily distinguishable from diverticulitis.     

Point-of-Care Ultrasound to Diagnose Colitis in the Emergency Department: A Case Series and Review of the Literature

BackgroundColitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point-of-care ultrasound (POCUS), one may occasionally be able to discern wall thickening, pericolic fluid, and adjacent hyperechoic mesenteric fat. One may also see abscesses, fistulae, or ascites.Case SeriesThis is a series of 6 patients who had findings consistent with colitis seen on POCUS performed by an emergency physician. These were confirmed by abdominal CT with contrast. Early detection by POCUS was able to lead to a rapid diagnosis and to expedite treatment.Why Should an Emergency Physician Be Aware of This?The ability to detect findings of colitis by POCUS can be quickly learned by the emergency physician with a strong background in basic ultrasound. For many of the different subtypes of colitis, the initial treatment in the emergency department is the same: i.v. antibiotics, i.v. fluids, and “bowel rest” by maintaining the patient in nothing-by-mouth status. For the stable patient with high clinical suspicion of an infectious etiology of colitis, ultrasound can help confirm the diagnosis and rule out other etiologies. This may be especially important in certain populations such as children and young women, where one can avoid a significant amount of radiation being directed toward the pelvic area.     

Ischemic colitis masquerading as colonic tumor: an unusual endoscopic presentation

A case of ischemic colitis masquerading as colonic submucosal tumor with no superficial mucosal lesion is reported. This unusual and less well known endoscopic presentation of colonic ischemia is emphasized and a rational approach to the management of ischemic colitis is discussed.     

缺血性结肠炎的临床及内镜特点分析

目的总结缺血性结肠炎的临床特点和内镜表现,为缺血性结肠炎的诊断和治疗提供依据。方法回顾性分析29例缺血性结肠炎的病例资料。结果本组29例缺血性结肠炎平均年龄59.6岁,60岁以上者17例（58.6%）;23例患者（79.3%）至少合并一种或一种以上基础疾病;临床表现：24例（85.8%）出现阵发性剧烈腹痛,21例（72.4%）有便血症状。内镜下病变肠管呈节段性分布,与正常肠管界限清楚,病变肠管黏膜表现为不同程度充血、水肿,血管纹理不能分辨,散在糜烂和大小形态不同的溃疡,左半结肠多见。26例（89.7%）痊愈,3例（10.3%）好转。结论内镜医师应掌握缺血性结肠炎临床表现及内镜特点,对伴有动脉硬化等基础病变的老年人,若出现腹痛、血便,早期行肠镜检查。缺血性结肠炎及时诊断和治疗,预后一般良好。     

11例缺血性结肠炎临床特点分析

目的探讨缺血性结肠炎的临床特点。方法对11例缺血性结肠炎的临床症状、体征及内镜表现进行分析总结。结果该病好发于老年人,多合并基础疾病,以腹痛、便血为主要表现,内镜检查病变主要发生在左半结肠,呈节段性分布,大多数病例呈一过性改变,预后良好。结论对于老年人出现腹痛、便血者,应考虑到缺血性结肠炎的可能,早期诊断和治疗是预后良好的关键。     

Ischemic colitis in marathon runners: a case-based review

In the United States over 450,000 participants finished a marathon in 2002. Some of them will present to an Emergency Department (ED) with a variety of gastrointestinal complaints. The diagnosis of ischemic colitis should be considered in patients who present with bloody diarrhea. We describe three patients who presented to our ED with abdominal pain and bloody diarrhea after a marathon. Gastrointestinal complaints with emphasis on mesenteric ischemia and ischemic colitis are discussed.     

老年人缺血性结肠炎临床特点

目的 :探讨老年缺血性结肠炎临床特点和易患因素。方法 :2 9例患者根据年龄分为老年组 (≥ 6 0岁 )和成年组 (<5 9岁 )。回顾分析其临床资料 ,并进行组间比较。结果 :(1)多数患者表现为腹痛、便血二联征 ,老年组肠梗阻发生率和病死率均高于成年组 ,但无显著差异。 (2 )老年组房颤患者显著多于成年组 (P <0 .0 5 ) ,动脉粥样硬化相关性疾病患病率显著高于成年组 (P <0 .0 0 1) ,而吸烟、高血压、糖尿病和高脂血症在两组间无显著差异。结论 :老年缺血性结肠炎临床表现典型 ,病情危重 ,病死率高。房颤和动脉粥样硬化相关性疾病是老年缺血性结肠炎的危险因素     

缺血性结肠炎的影像诊断

目的：评价气钡双重造影对缺血性结肠炎的诊断价值。材料与方法：由于缺血性结肠炎－过型多见，因此我们对10例患者在短期内作了多次气钡双重造影检查，观察其变化。结果：X线主要表现为：①指压痕；②管腔狭窄；③多发龛影；④囊袋状改变。结论：钡灌肠或气钡双重造影对本病的诊断有决定性意义，数日到数周内动态观察可发现明显的变化，有助确诊。     

Coronavirus disease 2019 (COVID-19) and ischemic colitis: An under-recognized complication

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. To our knowledge, there have not been any case reports of COVID-19 associated with ischemic colitis. Herein, we present the first case of a probable association of COVID-19 with ischemic colitis in a patient with a hypercoagulable state.     

Ischemic colitis associated with naratriptan and oral contraceptive use

Ischemic colitis has not been reported in association with naratriptan therapy. We describe the occurrence of ischemic colitis in a patient who was treated with abortive doses of naratriptan for migraine and was also taking long-term oral contraceptives. Concurrent use of naratriptan and oral contraceptives should probably be avoided.     

注射用血塞通治疗缺血性结肠炎的疗效观察

目的观察注射用血塞通治疗老年患者缺血性结肠炎的疗效。方法对34例老年缺血性结肠炎的患者随机分组,对照组(16例)给予单纯抗生素治疗和其他常规支持对症治疗;治疗组(18例)给予抗生素加注射用血塞通及常规支持治疗,观察治疗前后腹痛、便血的恢复情况,复查结肠镜比较肠黏膜的愈合情况。结果与对照组比较,治疗组腹痛、便潜血恢复的时间缩短,复查结肠镜黏膜恢复率高,治疗结束后黏膜修复状态更好。结论注射用血塞通对缺血性结肠炎症状的恢复、肠黏膜的修复有促进作用,有利于抑制缺血对肠黏膜的损伤。注射用血塞通可用于缺血性结肠炎的临床治疗。