Korean J Gastroenterol.  2019 Aug;74(2):115-118. 10.4166/kjg.2019.74.2.115.

Ischemic Colitis Associated with Rhabdomyolysis and Heat Stroke after an Intense Exercise in Young Adult

• Cha S
• Kwon BS
• Hong N
• Park JS
• Byun SK
• Choi SC
• Kim YS

• KMID: 2455775
• DOI: http://doi.org/10.4166/kjg.2019.74.2.115

Abstract

Ischemic colitis primarily affects the elderly with underlying disease, but it rarely occurs in young adults with risk factors, such as coagulopathy or vascular disorder. Moreover, it is extremely rare in the very young without risk factors. This paper presents a patient with ischemic colitis associated with heat stroke and rhabdomyolysis after intense exercise under high-temperature conditions. A 20-year-old man presented with mental deterioration after a vigorous soccer game for more than 30 minutes in sweltering weather. He also presented with hematochezia with abdominal pain. The laboratory tests revealed the following: AST 515 U/L, ALT 269 U/L, creatine kinase 23,181 U/L, BUN 29.1 mg/dL, creatinine 1.55 mg/dL, and red blood cell >50/high-power field in urine analysis. Sigmoidoscopy showed ischemic changes at the rectum and rectosigmoid junction. A diagnosis of ischemic colitis and rhabdomyolysis was made, and the patient recovered after conservative and fluid therapy. This case showed that a diagnosis of ischemic colitis should be considered in patients who present with abdominal pain and bloody diarrhea after intense exercise, and appropriate treatment should be initiated immediately.

Keyword

Colitis, ischemic; Exercise; Rhabdomyolysis; Young adult

MeSH Terms

Abdominal Pain
Aged
Colitis, Ischemic*
Creatine Kinase
Creatinine
Diagnosis
Diarrhea
Erythrocytes
Fluid Therapy
Gastrointestinal Hemorrhage
Heat Stroke*
Hot Temperature*
Humans
Rectum
Rhabdomyolysis*
Risk Factors
Sigmoidoscopy
Soccer
Weather
Young Adult*
Creatine Kinase
Creatinine

Figure

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  Fig. 1 Sigmoidoscopy taken on the second day of hospitalization revealed necrosis in the rectum and rectosigmoid junctional colonic mucosa.

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  Fig. 2 Abdominal computed tomography taken on the third day of hospitalization revealed mild wall thickening along with the rectum and rectosigmoid junction to the splenic flexure colon with irregular mucosal enhancement at the rectum and rectosigmoid junction.

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  Fig. 3 Follow-up sigmoidoscopy performed after 6 weeks revealed a normal appearance of colonic mucosa.

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