Case Report
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World J Gastroenterol. Oct 21, 2012; 18(39): 5640-5644
Published online Oct 21, 2012. doi: 10.3748/wjg.v18.i39.5640
Ischemic colitis and large bowel infarction: A case report
Eugen Florin Georgescu, Doina Carstea, Daniela Dumitrescu, Ramona Teodorescu, Andrei Carstea
Eugen Florin Georgescu, Ramona Teodorescu, Andrei Carstea, Department of Internal Medicine 1/Gastroenterology, Filantropia University Hospital of Craiova, 200136 Craiova, Romania
Doina Carstea, Department of Cardiology, Filantropia University Hospital of Craiova, 200136 Craiova, Romania
Daniela Dumitrescu, Department of Radiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Author contributions: All authors contributed equally to this manuscript.
Correspondence to: Eugen Florin Georgescu, Professor, Department of Internal Medicine 1/Gastroenterology, Filantropia University Hospital of Craiova, 200136 Craiova, Romania. efg@usa.net
Telephone: +40-744782136 Fax: +40-351813110
Received: April 3, 2012
Revised: June 14, 2012
Accepted: June 28, 2012
Published online: October 21, 2012
Abstract

Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data. In this paper, we present the case of a patient who was monitored in our unit for six years. For this patient, we encountered iterative changes in the clinical pattern, beginning with chronic “intestinal angina” and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis. This evolution is particularly rare in clinical practice, and the case is instructive because it raises discussions about the natural history of the condition and the therapeutic decisions that should be made at every stage of the disease. An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent “indistinct” abdominal symptoms. In these cases, aggressive investigation and therapeutic decisions must be taken whenever possible. Despite an absence of standardized protocols, angiographic evaluation and revascularization procedures have beneficial outcomes. Current advances in endovascular therapy, such as percutaneous transluminal angioplasty with stenting, should be increasingly used in patients with chronic mesenteric ischemia. Such therapy can avoid the risks that are associated with open repair. However, technical difficulties, especially in severe stenotic lesions, frequently occur.

Keywords: Ischemic colitis; Intestinal infarction; Mesenteric thrombosis; Acute mesenteric ischemia; Intestinal angina; Mesenteric atherosclerosis