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

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.

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

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.

Severe Ischemic Colitis from Gastric Ulcer Bleeding-Induced Shock in Patient with End Stage Renal Disease Receiving Hemodialysis

Upper gastrointestinal bleeding is a common condition and has various clinical courses and prognosis. End stage renal disease (ESRD) patients receiving hemodialysis have a high risk of vascular complications and increased risk of ischemic colitis. A 59-year-old male patient with ESRD receiving hemodialysis visited due to hematemesis. After admission, he showed recurrent hematemesis and hypovolemic shock. Upper esophagogastroduodenoscopy revealed gastric ulcer bleeding and endoscopic hemostasis was successfully performed. Blood transfusion and norepinephrine was administered for hypovolemic shock during initial 3 days. Ten days later, he exhibited hematochezia. Sigmoidoscopy revealed necrotic ischemic colitis in sigmoid colon and segmental colectomy was performed. However, recurrent leakage and ischemia were developed in colon as well as small bowel, and he finally died after 55 hospital days in spite of additional operations. Here, we report a case of peptic ulcer bleeding in patient with ESRD who suffered a severe form of ischemic colitis with transmural necrosis.

Idiopathic Isolated Perigastric Omental Panniculitis

Mesenteric panniculitis (MP) is non-specific inflammation of the adipose tissue that primarily involves the small bowel mesentery. Omental involvement has been rarely reported but we report a case of 25 years old woman with isolated lesser omental panniculitis. This patient was diagnosed by CT findings and recovered completely with conservative treatment. Invasive diagnostic methods or surgical exploration has been used to diagnose MP. However, all six reported cases of omental panniculitis including the current case showed a benign course; therefore, awareness of the CT findings is essential for the best diagnosis and management of omental panniculitis.