Korean J Gastroenterol.  2022 Aug;80(2):93-98. 10.4166/kjg.2022.023.

Ischemic Colitis Presented as Pseudomembranous Colitis: An Untypical Case from Vietnam

• Huynh TM
• Le QD
• Nguyen Bui KL
• Huynh Bui MQ
• Hong Vo CM
• Quach DT

• KMID: 2532684
• DOI: http://doi.org/10.4166/kjg.2022.023

Abstract

Ischemic colitis (IC) is an underreported chronic disease characterized by the hypoperfusion of the bowel mucosa. The diagnosis and treatment may be challenging because its clinical course resembles other colitis or even colorectal malignancies. This paper reports an untypical case to underline the diversity of IC manifestation. A 68-year-old man with several comorbidities was admitted because of abdominal pain with a 6-month duration and a mass in the left lower quadrant. Colonoscopy revealed erosive pseudomembranous colitis narrowed colon segments with ulcerated mucosa mimicking colorectal cancer and inflammatory bowel disease. The stool cultures and Clostridium difficile toxin tests were negative. After the failure of conservative therapy, the Hartmann procedure with temporary ileostomy was performed uneventfully. The histological results of the surgical specimens revealed IC with focal pseudomembranous areas.

Keyword

Colitis; ischemic; Inflammatory bowel diseases; Collective neoplasm; Enterocolitis; pseudomembranous; Vietnam

Figure

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  Fig. 1 Computed tomography (CT) findings. (A) Abdominal CT showed diffuse wall thickening of the splenic flexure wall-thickening, and no calcifi cations within the bowel wall and mesentery vein were observed, left colon segments with serosal infiltration (arrows). (B) 3D reconstruction from CT angiography revealed the diffuse atherosclerosis of multivessel but no severe stenosis in the main abdominal branches of the aorta.

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  Fig. 2 Images from flexible sigmoidoscopy showing. (A-C) Before treatment, the ischemic bowel segments had dilated lumens, yellowish exudate (pseudomembranes), ulcers on the mucosal surface, and an ulcero-infiltrative mass-like lesion caused by a severely inflamed non-traversable stricture at the splenic flexure. (D-F) After treatment, the mucosa of the colon segments became friable and ulcerated with necrotic-like appearances.

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  Fig. 3 Histopathology examination of the endoscopic and surgical specimens. (A) Endoscopic biopsy specimens revealed unspecific moderate chronic active inflammation, mild hyalinization of the lamina propria, with microthrombi, without granulomas, cytopathic viral inclusion, and dysplasia (hematoxylin and eosin stain [H&E], ×100). The final surgical specimens showed the following: (B) marked acute inflammatory exudate on the mucosa (pseudomembranous appearance) (white arrow and black arrows), crypt abscess and atrophy, mucosal necrosis (stars) (H&E, ×40). (C) Ischemic colitis with ischemic changes including mucosal edema, lamina propria hemorrhage (white arrows), lamina propria hyalinization & capillary dilatation (black arrows) (H&E, ×200).

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