Kingshuk Mazumdar, MBA, Kelly Russo, BS; Albany Medical College, Albany, NY
Introduction: Generally considered a diagnosis of the elderly with cardiovascular comorbidities, ischemic colitis results from poor colonic perfusion and most commonly manifests with abdominal pain (90% of cases), diarrhea (50% of cases), and rectal bleeding (40% of cases). Symptomatic patients undergoing endoscopic evaluation for suspected disease characteristically demonstrate segmental mucosal changes that confirm diagnosis via direct visualization and tissue sampling. In rare cases, ischemic change may manifest as a solitary mass, raising concern for malignancy. Here, we present the case of an asymptomatic 70-year-old male found to have a mass in the ascending colon, later biopsy-confirmed to be ischemic colitis.
Methods: A 70-year-old Caucasian male with history of right-sided adenomatous polyp removal underwent follow-up surveillance colonoscopy during which he was found to have a 3 cm firm, ulcerated, friable lesion in the ascending colon distal to the ileocecal valve. Prior to the procedure, the patient denied any recent history of abdominal pain, weight loss, gastrointestinal bleeding, or changes in bowel habits. Physical examination at this time revealed stable vital signs with unremarkable cardiovascular and gastrointestinal exams. Laboratory evaluation demonstrated normal WBC and Hb. Medical and surgical history were non-contributory. The patient was a former smoker of 20 years, and medications included aspirin and omeprazole.
During the procedure, the mass was extensively biopsied, revealing evidence of ischemic colitis without dysplasia or carcinoma. A CT of the abdomen and pelvis was subsequently ordered, though the patient did not follow up with imaging. The patient was managed conservatively with a 2-week course of ciprofloxacin and metronidazole and scheduled for follow-up. Colonoscopy performed 3 months later revealed complete resolution of the lesion with normal colonic mucosa. Discussion: Mass-forming ischemic colitis is an atypical variant of disease that may closely mimic malignancy. The role of biopsy in facilitating diagnosis, especially in the absence of characteristic symptoms, is thus crucial. The few cases of mass-forming ischemic colitis that have been documented demonstrate a predilection for the proximal colon with complete resolution on follow-up, consistent with the current report. Recognition of this unique presentation allows for avoidance of unnecessary surgical intervention in favor of conservative management.
Figure 1. Colonoscopy image demonstrating 3 cm friable mass in the ascending colon.
Figure 2. Colonoscopy image demonstrating complete resolution of mass with normal colonic mucosa 3 months after initial presentation.
Disclosures: Kingshuk Mazumdar indicated no relevant financial relationships. Kelly Russo indicated no relevant financial relationships.