Mohammed A. Ansari, MD1, Deepak Kesani, DO2, Mohammed Waseem Ansari, MD3, Randa Abdelmasih, MBBCh1, Ramy Abdelmaseih, MBBCh1, Khalid Abusaada, MD2; 1Ocala Regional Medical Center, Ocala, FL; 2University of Central Florida College of Medicine, Ocala, FL; 3University of Kansas Medical Center, Ocala, FL
Introduction: This is a case of an unusual endoscopic presentation of ischemic colitis as a large protrusion into the colonic lumen which could be mistaken for a neoplasm.
Methods: A 51-year-old woman with a history of iron deficiency anemia, osteoporosis and endometriosis presented with new onset abdominal pain which began 3 weeks prior to presentation as a dull, intermittent, generalized, non-radiating abdominal pain. A week prior to presentation she had one episode of bloody bowel movement and an episode of non-bilious, non-bloody vomiting. Patient endorsed generalized weakness and fatigue. Her only medication was Alendronate 70mg Q7 days. Her physical exam was positive for slight tenderness upon palpation of the right lower quadrant of the abdomen. Laboratory work revealed white blood cell count 9.2, hemoglobin 13.5. Computed Tomography (CT) abdomen and pelvis suggested infectious colitis of right and transverse colon. Colonoscopy performed on day two of admission showed linear striped erythema in the descending sigmoid and transverse colon consistent with ischemic colitis and there was a protruding polypoid lesion surrounded by ulceration in the cecum. Biopsies of the polypoid lesion were taken and the results were positive for ischemic colitis and were negative for dysplasia or malignancy. Stool culture studies were positive for Campylobacter AG. Patient was discharged on azithromycin 500 mg for 3 days, famotidine 20mg twice daily for 5 days and prednisone 20mg for 5 days.
A repeat colonoscopy performed 4 weeks later revealed localized erosion in the transverse colon and cecum with complete healing of the polypoid mass like lesion. The linear erythema noted on initial colonoscopy was absent on repeat colonoscopy. Localized erosion was noted in the transverse colon. Repeat biopsy of lesions and stool tests performed were normal. Discussion: This patient had a protruding polyp like lesion surrounded by ulceration in the cecum which suggested a neoplastic change. Multiple factors may be contributing to the development of ischemic colitis in this case including Campylobacter infection, use of bisphosphonates. Another possible contributor to the protrusion could have been normal intra-abdominal pressure combined with mucosal tissue edema and weakening, producing localized mucosal invagination into the lumen and polypoid formation.
Figure 1. Polypoid mass
Figure 2. Polypoid mass with a surrounding ulcer.
Figure 3. Linear striped erythema.
Disclosures: Mohammed Ansari indicated no relevant financial relationships. Deepak Kesani indicated no relevant financial relationships. Mohammed Waseem Ansari indicated no relevant financial relationships. Randa Abdelmasih indicated no relevant financial relationships. Ramy Abdelmaseih indicated no relevant financial relationships. Khalid Abusaada indicated no relevant financial relationships.