Atypical Multisegmental Involvement in Suspected Ischemic Colitis: A Case Report
- 1Internal Medicine, Wyckoff Heights Medical Center, New York, USA
Abstract
We report a case compatible with ischemic colitis in a 68-year-old man with hypertension, coronary artery disease treated with three stents, peripheral arterial disease, and diabetes mellitus who presented with acute abdominal pain, vomiting, and bloody diarrhea. Initial white blood cell count was 22.2 K/µL, and serum lactate was 0.8 mmol/L. Contrast-enhanced CT demonstrated multisegmental colitis. Colonoscopy showed severe, noncontiguous inflammation involving the rectum, sigmoid colon, hepatic flexure, ascending colon, and cecum, with a normal terminal ileum. Sharply demarcated ulceration and dusky mucosa favored ischemia, although these findings were not diagnostic. The patient remained hemodynamically stable without peritoneal signs and improved with bowel rest, intravenous fluids, ceftriaxone plus metronidazole, surgical consultation, and serial abdominal examinations. No operation was performed. The ischemic mechanism remained indeterminate: dedicated vascular imaging and colonic histopathology were unavailable, stool studies were not obtained, and infectious or other mimics could not be excluded definitively. This case illustrates that suspected ischemic colitis can have atypical rectal and right-sided involvement despite a relatively benign examination and a lactate within the reference range. In this clinically stable patient, close surgical observation supported continued nonoperative treatment despite guideline features of severe disease.
Related
- An Atypical Abdominal Presentation of Pancreatic Panniculitis in a Patient With Suspected Pancreatic Cancer: A Case Report
- Suspected Seronegative Spondyloarthropathy in a Young Woman With Ulcerative Colitis and Concurrent Bleeding Symptoms
- Case Report: Three rare cases of pseudomyogenic hemangioendothelioma with atypical skeletal involvement
- An Atypical Presentation of Richter's Transformation in Chronic Lymphocytic Leukemia: Stroke-Like Onset With Multiorgan Involvement Including the Heart and Seminal Vesicles
- Case Report: Primary epithelioid angiosarcoma of the femur: two rare cases with atypical skeletal involvement
BibTeX
@article{mah2026atypical,
title = {{Atypical Multisegmental Involvement in Suspected Ischemic Colitis: A Case Report}},
author = {Henry K Mah and John A Spallanzani and Mike De Leonardis and Alex Shu and Roxana Lazarescu},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117150},
url = {https://europepmc.org/article/PMC/PMC13718528},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atypical Multisegmental Involvement in Suspected Ischemic Colitis: A Case Report
AU - Henry K Mah
AU - John A Spallanzani
AU - Mike De Leonardis
AU - Alex Shu
AU - Roxana Lazarescu
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117150
UR - https://europepmc.org/article/PMC/PMC13718528
AB - We report a case compatible with ischemic colitis in a 68-year-old man with hypertension, coronary artery disease treated with three stents, peripheral arterial disease, and diabetes mellitus who presented with acute abdominal pain, vomiting, and bloody diarrhea. Initial white blood cell count was 22.2 K/µL, and serum lactate was 0.8 mmol/L. Contrast-enhanced CT demonstrated multisegmental colitis. Colonoscopy showed severe, noncontiguous inflammation involving the rectum, sigmoid colon, hepatic flexure, ascending colon, and cecum, with a normal terminal ileum. Sharply demarcated ulceration and dusky mucosa favored ischemia, although these findings were not diagnostic. The patient remained hemodynamically stable without peritoneal signs and improved with bowel rest, intravenous fluids, ceftriaxone plus metronidazole, surgical consultation, and serial abdominal examinations. No operation was performed. The ischemic mechanism remained indeterminate: dedicated vascular imaging and colonic histopathology were unavailable, stool studies were not obtained, and infectious or other mimics could not be excluded definitively. This case illustrates that suspected ischemic colitis can have atypical rectal and right-sided involvement despite a relatively benign examination and a lactate within the reference range. In this clinically stable patient, close surgical observation supported continued nonoperative treatment despite guideline features of severe disease.
SN - 2168-8184
ER -