Korean J Gastroenterol.  2020 Apr;75(4):216-219. 10.4166/kjg.2020.75.4.216.

Ischemic Colitis Associated with Low-volume Oral Sulfate Solution for Bowel Preparation

• Chung JW
• Lee JM
• Sohn YW
• Han WC
• Yoon K

• KMID: 2504239
• DOI: http://doi.org/10.4166/kjg.2020.75.4.216

Abstract

Ischemic colitis resulting from bowel preparation for colonoscopy is extremely rare, with only a small number of cases with polyethylene glycol having been reported. Here, we present a patient with ischemic colitis after administration of a low-volume oral sulfate solution (OSS). A 49-year-old female without any significant medical history experienced abdominal pain, vomiting, and hematochezia after ingestion of OSS. She complained of severe abdominal pain during colonoscopy, and diffuse edema, hyperemia, friability, and shallow erosions were present on the transverse, descending, and sigmoid colons. A mucosal biopsy revealed mixed lymphoid inflammatory cell infiltration with de-epithelialization, whereas an abdominal CT scan showed submucosal edema on the transverse colon. A diagnosis of ischemic colitis was made. The patient recovered with fluid and antibiotic therapy without significant sequelae. Although OSS is a clinically validated and generally safe bowel preparation agent, ischemic colitis is a rare complication that should be considered.

Keyword

Colitis, ischemic; Bowel preparation; Colonoscopy

Figure

• 

  Fig. 1 Colonoscopy revealed diffuse edematous hyperemic inflammation, shallow erosions, and friability in mucosa of (A) sigmoid and (B) transverse colons.

• 

  Fig. 2 Abdominal computed tomography revealed submucosal edema of transverse colon (A) transverse section and (B) coronal section.

• 

  Fig. 3 (A, B) Histologic examination of sigmoid and transverse colonic mucosa showed mixed lymphoplastic cell infiltration (arrows) and de-epithelialization, consistent with ischemic colitis (A: H&E, ×40; B: H&E, ×200).

Reference

1. Sreenarasimhaiah J. 2005; Diagnosis and management of ischemic colitis. Curr Gastroenterol Rep. 7:421–426. DOI: 10.1007/s11894-005-0013-1. PMID: 16168242.

2. Green BT, Tendler DA. 2005; Ischemic colitis: a clinical review. South Med J. 98:217–222. DOI: 10.1097/01.SMJ.0000145399.35851.10. PMID: 15759953.

3. Theodoropoulou A, Koutroubakis IE. 2008; Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol. 14:7302–7308. DOI: 10.3748/wjg.14.7302. PMID: 19109863. PMCID: PMC2778113.

4. Baudet JS, Castro V, Redondo I. 2010; Recurrent ischemic colitis induced by colonoscopy bowel lavage. Am J Gastroenterol. 105:700–701. DOI: 10.1038/ajg.2009.637. PMID: 20203651.

5. Higgins PD, Davis KJ, Laine L. 2004; Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther. 19:729–738. DOI: 10.1111/j.1365-2036.2004.01903.x. PMID: 15043513.

6. Lee SO, Kim SH, Jung SH, et al. 2014; Colonoscopy-induced ischemic colitis in patients without risk factors. World J Gastroenterol. 20:3698–3702. DOI: 10.3748/wjg.v20.i13.3698. PMID: 24707156. PMCID: PMC3974540.

7. Oh JK, Meiselman M, Lataif LE Jr. 1997; Ischemic colitis caused by oral hyperosmotic saline laxatives. Gastrointest Endosc. 45:319–322. DOI: 10.1016/S0016-5107(97)70282-7. PMID: 9087846.

8. Park JE, Moon W, Nam JH, et al. 2007; A case of ischemic colitis presenting as bloody diarrhea after normal saline enema. Korean J Gastroenterol. 50:126–130. PMID: 17928757.

9. Wexner SD, Beck DE, Baron TH, et al. 2006; A consensus document on bowel preparation before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointest Endosc. 63:894–909. DOI: 10.1016/j.gie.2006.03.918. PMID: 16733101.

10. Di Palma JA, Smith JR, Cleveland Mv. 2002; Overnight efficacy of polyethylene glycol laxative. Am J Gastroenterol. 97:1776–1779. DOI: 10.1111/j.1572-0241.2002.05840.x. PMID: 12135034.

11. Rex DK, Di Palma JA, Rodriguez R, McGowan J, Cleveland M. 2010; A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc. 72:328–336. DOI: 10.1016/j.gie.2010.03.1054. PMID: 20646695.

12. Kim B, Lee SD, Han KS, et al. 2017; Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation: a randomized, multicenter phase III clinical trial. Dis Colon Rectum. 60:426–432. DOI: 10.1097/DCR.0000000000000759. PMID: 28267011.

13. Patel V, Nicar M, Emmett M, et al. 2009; Intestinal and renal effects of low-volume phosphate and sulfate cathartic solutions designed for cleansing the colon: pathophysiological studies in five normal subjects. Am J Gastroenterol. 104:953–965. DOI: 10.1038/ajg.2008.124. PMID: 19240703.

14. Anastassopoulos K, Farraye FA, Knight T, Colman S, Cleveland MV, Pelham RW. 2016; A comparative study of treatment-emergent adverse events following use of common bowel preparations among a colonoscopy screening population: results from a post-marketing observational study. Dig Dis Sci. 61:2993–3006. DOI: 10.1007/s10620-016-4214-2. PMID: 27278957. PMCID: PMC5020112.

15. Hass DJ, Kozuch P, Brandt LJ. 2007; Pharmacologically mediated colon ischemia. Am J Gastroenterol. 102:1765–1780. DOI: 10.1111/j.1572-0241.2007.01260.x. PMID: 17488249.