Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.142
Peer-review started: August 28, 2023
First decision: November 20, 2023
Revised: December 3, 2023
Accepted: December 14, 2023
Article in press: December 14, 2023
Published online: January 6, 2024
Processing time: 127 Days and 4.8 Hours
Congestive ischemic colitis is a rare subtype of ischemic colitis with an unknown pathophysiology. Excluding conservative management, such as fasting, no established treatment exists; therefore, surgical intervention should be considered in some cases if symptoms worsen. Current literature suggests that anti-inflammatory agents may effectively treat congestive ischemic colitis.
We present the case of a 68-year-old female patient who underwent laparoscopic left hemicolectomy for transverse colon cancer 3 years ago. Postoperatively, follow-up included an annual colonoscopy and abdominal computed tomography (CT) at a local clinic. However, progressive erythema and edema of the sigmoid colon were observed 1 year postoperatively. Upon admission to our hospital, she complained of abdominal pain and diarrhea. Abdominal CT showed thickening of the sigmoid colon walls, and colonoscopy revealed erythema, edema, and multiple ulcers with exudate in the sigmoid colon. CT angiography showed engorgement of the sigmoid vasa recta without any vascular abnormalities. The diagnosis was congestive ischemic colitis, and we treated the patient with anti-inflammatory agents. After 2 mo of glucocorticoid therapy (20 mg once daily) and 7 mo of 5-aminosalicylate therapy (1 g twice daily), the ulcers completely healed. She has not experienced any recurrence for 2 years.
Anti-inflammatory therapy, specifically glucocorticoids and 5-aminosalicylate, has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.
Core Tip: Congestive ischemic colitis is a rare type of ischemic colitis whose diagnosis requires a comprehensive assessment. Since no clear treatment guidelines exist, surgical treatment should be considered if symptoms worsen during bowel rest. We report, for the first time, the successful treatment of congestive ischemic colitis occurring after left hemicolectomy with glucocorticoids and 5-aminosalicylate. Follow-up revealed complete healing of the sigmoid ulcers without recurrences in the past 2 years.