A previously fit 23 year old adult male who presented with a sudden onset of profound autonomic neuropathy, for which no cause could be found, is described. The patient subsequently developed ischaemic enterocolitis that ultimately necessitated colectomy and subtotal enterectomy. Potential neural and humoral mechanisms are discussed. (+info)
Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach.
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OBJECTIVES: to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine. METHOD: a review of the literature according to evidence-based principles was made by all doctors of our department. RESULTS: seven prospective non-randomised reports on routine colonoscopy after abdominal aortic surgery were found. None of the participants found all the reports, and the last was identified by the reviewer. CONCLUSIONS: Endoscopy may disclose ischaemic colitis, but cannot separate transmural from the clinically less important mucosal ischaemia. Endoscopy had no impact on mortality in any of the prospective series. The evidence-based conference was an inspiring teaching modality, and illustrated for the participants the difficulty in performing a targeted literature search. (+info)
Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis.
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We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. Histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery. (+info)
Rare complications of endoscopic retrograde cholangiopancreatography: two case reports.
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BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure with several known risks. We present two rarely reported complications of ERCP and sphincterotomy: transverse mesocolon disruption with ischemic colitis and splenic rupture. RESULTS: The first patient, a 54-year-old female, presented one day following ERCP and stent revision for pancreas divisum. She presented with hypotension and abdominal distention. An abdominal computed tomography (CT) showed a ruptured spleen, which was confirmed on laparotomy. She had a complicated postoperative course and died of multiple organ failure. The second patient is a 56-year-old female who presented five days after ERCP and sphincterotomy with abdominal pain, abdominal wall ecchymosis, and decreasing hematocrit. Her evaluation included hospital admission and abdominal CT scan, which showed free fluid and a large hematoma in the transverse mesocolon. These findings were confirmed on laparotomy and a devascularized segment of bowel was resected. CONCLUSION: Only 6 cases of ERCP-related splenic injury have been reported in the literature. One additional report is available of a fatal splenic artery injury. No previous reports exist of a mesenteric hematoma resulting in bowel devascularization. Prompt evaluation and awareness of potential complications should help capture potentially life-threatening sequelae of ERCP. (+info)
Complete small bowel recovery after prolonged total venous occlusion.
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Acute small bowel ischaemia is a mostly irreversible condition associated with high mortality. Here we report the case of a patient after severe abdominal trauma in whom the superior mesenteric vein (SMV) was completely occluded for more than 15 h in the absence of any collateral venous drainage. Following surgical reconstruction of the SMV and with scheduled relaparotomies for 5 days, the bowel showed slow recovery. Now the patient is well and on complete oral nutrition. (+info)
Fulminant ischaemic colitis with atypical clinical features complicating sickle cell disease.
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Clinically significant ischaemic bowel injury is an exceedingly rare complication of sickle cell disease. It manifests as acute surgical abdomen and may respond to conservative treatment. An unusual fatal case of ischaemic colitis with minimal abdominal findings in a young male during a sickle cell vaso-occlusive pain crisis is described. This case demonstrates that an acute surgical abdomen should be considered in such patients who fail to respond to conservative management as untreated this condition may be fatal. (+info)
Endothelin-1 induces mucosal mast cell degranulation and tissue injury via ETA receptors.
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The effects of endothelin-1 (ET-1) on mucosal mast cells are of special interest, since they may be an important component of the tissue response that occurs during ischaemic preconditioning or ischaemia/re-oxygenation injuries. Increasing doses of ET-1 were administered intravenously to anaesthetized rats. In a second series of experiments, animals were pretreated with the ET(A) receptor antagonists BQ-610 or ETR-P1/fl peptide, or with the ET(B) receptor antagonist IRL-1038. Intestinal perfusion changes were recorded, and the proportion of degranulated mast cells and the degree of mucosal damage were determined in ileal biopsies. ET-1 induced dose-dependent alterations in the haemodynamic and morphological parameters, and caused significant mast cell degranulation. These changes were inhibited significantly by pretreatment with the ET(A) receptor antagonists, but not with the ET(B) receptor antagonist. We conclude that a cross-talk exists between endothelial cell-derived humoral mediators and the intestinal mast cell system. (+info)
Colonic necrosis and perforation secondary to Escherichia coli O157:H7 gastroenteritis in an adult patient without hemolytic uremic syndrome.
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During a multistate outbreak of Escherichia coli O157:H7 diarrhea, we encountered a woman who had hemorrhagic colitis complicated by ischemic colitis with perforation. To our knowledge, this has not previously been described in adult patients. Because of the insensitivity of the commonly used diagnostic methods, this condition may be underrecognized. (+info)