Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2024; 12(1): 142-147
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.142
Congestive ischemic colitis successfully treated with anti-inflammatory therapy: A case report
Geon Woo Lee, Su Bum Park
Geon Woo Lee, Su Bum Park, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
Author contributions: Park SB and Lee GW contributed to the acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su Bum Park, MD, PhD, Associate Professor, Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan 50612, South Korea. psubumi@naver.com
Received: August 28, 2023
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Anti-inflammatory therapy, specifically glucocorticoids and 5-aminosalicylate, has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.

Keywords: Ischemic colitis, Glucocorticoids, 5-aminosalicylate, Colon cancer, Colectomy, Case report

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.