Published online Jul 16, 2023. doi: 10.12998/wjcc.v11.i20.4937
Peer-review started: April 5, 2023
First decision: April 27, 2023
Revised: May 10, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: July 16, 2023
Processing time: 91 Days and 20 Hours
Ischemic colitis (IC) is common, rising in incidence and associated with high mortality. Its presentation, disease behavior and severity vary widely, and there is significant heterogeneity in therapeutic strategies and prognosis. The common causes of IC include thromboembolism, hemodynamic insufficiency, iatrogenic factors and drug-induced. However, contrast-induced IC, especially isolated right colon ischemia is rarely reported.
A 52-year-old man was admitted to the hospital due to intermittent chest distress accompanied by palpitation. Coronary angiography was performed using 60 mL of the iodinated contrast agent iohexol (Omnipaque 300), and revealed moderate stenosis of the left anterior descending artery and right coronary artery. At 3 h post-procedure, he complained of epigastric pain without fever, diarrhea and vomiting. Vital signs remained normal. An iodixanol-enhanced abdominal computed tomography (CT) scan revealed thickening, edema of the ascending and right transverse colonic wall and inflammatory exudate, without thrombus in mesenteric arteries and veins. Following 4 days of treatment with antibiotic and supportive management, the patient had a quick and excellent recovery with disappearance of abdominal pain, normalization of leucocyte count and a significant decrease in C reactive protein. There was no recurrence of abdominal pain during the patient's two-year follow-up.
This case emphasizes that contrast-induced IC should be considered in the differential diagnosis of unexplained abdominal pain after a cardiovascular interventional procedure with the administration of contrast media. Timely imaging evaluation by CT and early diagnosis help to improve the prognosis of IC.
Core Tip: Ischemic colitis (IC) is the most frequently encountered intestinal ischemia and is associated with high mortality. Here, we describe a case of isolated right colon ischemia in a 52-year-old gentleman following a diagnostic coronary angiography that involved 60 mL of iohexol (Omnipaque 300). This case highlights that clinicans should be aware of contrast-induced IC and considered in the differential diagnosis of unexplained abdominal pain after a cardiovascular interventional procedure with the administration of contrast media. Risk stratification should be carried out as soon as possible based on clinical characteristics to ensure appropriate treatment strategies.