New York-Presbyterian/Weill Cornell Medical Center New York, NY, United States
Bianca Di Cocco, MD1, Zachary Sherman, MD2, David Wan, MD3 1New York-Presbyterian/Weill Cornell Medical Center, New York, NY; 2New York Presbyterian - Weill Cornell Medical Center, New York, NY; 3New York Presbyterian Weill Cornell Medicine, New York, NY
Introduction: Ischemic colitis is an inflammatory condition caused by a reduction in blood flow to the colon. It is most often seen in older adults presenting with acute lower abdominal pain and hematochezia. Its appearance on endoscopy can range from erythematous, friable mucosa, to cyanotic mucosa with ulcerations. We present a case of ischemic colitis that mimicked colorectal cancer.
Case Description/Methods: A 73-year-old woman with coronary artery disease, peripheral vascular disease, and a 30-pack-year smoking history presented with one day of intense right lower quadrant abdominal pain and diarrhea. Prior to her presentation, she had had several years of intermittent post-prandial abdominal pain and a 20-lb unintentional weight loss.
The patient underwent computed tomography (CT) of the abdomen and pelvis which showed circumferential wall thickening in the cecum and proximal ascending colon with pericolonic mesenteric nodes concerning for cecal neoplasm or segmental colitis. During colonoscopy, a frond-like, ulcerated, partially-obstructing mass was found in the cecum (Figure 1a). Gross appearance was concerning for an atypical-appearing adenocarcinoma. Biopsies of the mass revealed acute ischemic colitis with no underlying neoplasm, and CT angiography showed severe atherosclerosis at the origins of the celiac and superior mesenteric arteries. The patient’s symptoms improved with supportive care. Repeat colonoscopy one month later showed significant improvement with residual right-sided colonic erythema and scattered pale regions of mucosa thought to be due to hypoperfusion (Figure 1b). Repeat biopsies again confirmed ischemic colitis without evidence of malignancy.
Discussion: The patient’s case was initially concerning for a colorectal cancer given significant weight loss and apparent mass. However, biopsies were consistent with acute ischemic colitis, which improved on repeat colonoscopy. CT scan can differentiate ischemic colitis from colon cancer in 75% of cases, but colonoscopy is preferred, as it allows for direct visualization and biopsies. In approximately 20% of ischemic colitis cases, there is a coexisting colonic carcinoma. Given an atypical appearance of a lesion with initial pathology read as ischemic colitis, a repeat colonoscopy with additional biopsies can be helpful in confirming the diagnosis.
Figure: Figure 1a: Ulcerated mass in cecum as seen on initial colonoscopy. Figure 1b: Cecum on repeat colonoscopy one month later with marked improvement in ulcerations.
Disclosures: Bianca Di Cocco indicated no relevant financial relationships. Zachary Sherman indicated no relevant financial relationships. David Wan indicated no relevant financial relationships.
Bianca Di Cocco, MD1, Zachary Sherman, MD2, David Wan, MD3. P0171 - A Case of Ischemic Colitis Mimicking Colorectal Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.