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ischemic colitis induced by a platelet-raising capsule: A case report

World Journal of Clinical Cases 2024年第3期12卷 607-615页

作者： Chen-Lu Wang Ze-Kun Si Guo-Hong Liu Chen Chen Hui Zhao Lei Li The Affiliated Hospital of Shandong Second Medical University School of Clinical MedicineShandong Second Medical UniversityWeifang 261000Shandong ProvinceChina Department of Gastroenterology The Affiliated Hospital of Shandong Second Medical UniversityWeifang 261000Shandong ProvinceChina

BACKGROUND ischemic colitis(IC)is also known as colon ischemia and is caused by colon vascular occlusion or nonocclusion,which results in a reduced blood supply to the colon and is not significant enough to maintain the metabolic function of cells,leading to intestinal wall ischemia.Its main symptoms include abdominal pain,diarrhea,and bloody stool.In severe cases,intestinal gangrene,peritonitis,intestinal stenosis and even intestinal obstruction may occur.IC induced by long-term use of certain special drugs is relatively rare in clinical practice.This article describes the clinical diagnosis and treatment of a typical case and provides a new treatment idea for the treatment of IC.CASE SUMMARY The patient was admitted to the hospital with"abdominal pain for half a month and bloody stool with mucous and pus for 3 d"and was diagnosed with"IC".Symptomatic and supportive treatment,such as antibiotics(levofloxacin),acid inhibition and stomach protection,fluid replenishment,and intravenous nutrition,was given.The patient's colonic ulcers were considered to be related to the oral administration of platelet(PLT)-raising capsules;the patient was asked to stop PLT-raising drugs for selective review via colonoscopy,and antibiotics and mesalazine enteric-coated tablets were stopped.Under the guidance of hematology consultation,60 mg of methylprednisolone was given in combination with PLT infusion to increase the PLT.After treatment,the patient's condition stabilized,the patient’s stool turned yellow,the patient’s symptoms improved,and the patient was allowed to leave the hospital.CONCLUSION PLT-raising capsules can lead to IC,so clinicians should have a full understanding of the application of these drugs in the treatment of various causes of thrombocyt-INTRODUCTION ischemic colitis(IC)is also known as colon ischemia(CI)and is caused by colon vascular occlusion or nonocclusion,which results in a reduced blood supply to the colon;this process is not significant enough to maintain the metabolic function of cells,leading to int

关键词： Platelet-raising capsule ischemic colitis Drug-related Colonic ulcer Case report

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Congestive ischemic colitis successfully treated with antiinflammatory therapy: A case report

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World Journal of Clinical Cases 2024年第1期12卷 142-147页

作者： Geon Woo Lee Su Bum Park Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsan 50612South Korea

BACKGROUND Congestive ischemic colitis is a rare subtype of ischemic colitis with an unknown pathophysiology.Excluding conservative management,such as fasting,no established treatment exists;therefore,surgical intervention should be considered in some cases if symptoms worsen.Current literature suggests that anti-inflam-matory agents may effectively treat congestive ischemic colitis.CASE SUMMARY We present the case of a 68-year-old female patient who underwent laparoscopic left hemicolectomy for transverse colon cancer 3 years ago.Postoperatively,follow-up included an annual colonoscopy and abdominal computed tomography(CT)at a local clinic.However,progressive erythema and edema of the sigmoid colon were observed 1 year postoperatively.Upon admission to our hospital,she complained of abdominal pain and diarrhea.Abdominal CT showed thickening of the sigmoid colon walls,and colonoscopy revealed erythema,edema,and multiple ulcers with exudate in the sigmoid colon.CT angiography showed engorgement of the sigmoid vasa recta without any vascular abnormalities.The diagnosis was congestive ischemic colitis,and we treated the patient with anti-inflammatory agents.After 2 mo of glucocorticoid therapy(20 mg once daily)and 7 mo of 5-aminosalicylate therapy(1 g twice daily),the ulcers completely healed.She has not experienced any recurrence for 2 years.CONCLUSION Anti-inflammatory therapy,specifically glucocorticoids and 5-aminosalicylate,has demonstrated promising efficacy and introduces potential novel treatment options for congestive ischemic colitis.

关键词： ischemic colitis Glucocorticoids 5-aminosalicylate Colon cancer

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ischemic colitis after receiving the second dose of a COVID-19 inactivated vaccine: A case report

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World Journal of Clinical Cases 2022年第12期10卷 3866-3871页

作者： Mei-Hua Cui Xiao-Lin Hou Jun-Yuan Liu Department of Gastroenterology Aerospace Center HospitalBeijing 100049China

BACKGROUND The outbreak of the coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020.COVID-19 inactivated vaccines play a crucial role in reducing the rates of morbidity and mortality.CASE SUMMARY We presented a 48-year-old woman from Haidian District,Beijing,China who developed ischemic colitis after receiving the second dose of COVID-19 inactivated vaccine.Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon.Colonoscopy revealed hyperemia,edema and erosion of the mucosa with superficial ulceration and a yellow-white coating at the descending colon and sigmoid colon.The symptoms were relieved after 1 wk of receiving pinaverium bromide(50 mg,tid)and aspirin enteric-coated tablets(0.1 g,qd).CONCLUSION The possible occurrence of ischemic colitis should be considered after administration of the COVID-19 inactivated vaccines.

关键词： COVID-19 Vaccine ischemic colitis Adverse event Case report

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Contrast-induced ischemic colitis following coronary angiography:A case report

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World Journal of Clinical Cases 2023年第20期11卷 4937-4943页

作者： Hui Qiu Wei-Ping Li Department of Cardiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND ischemic colitis(IC)is common,rising in incidence and associated with high mortality.Its presentation,disease behavior and severity vary widely,and there is significant heterogeneity in therapeutic strategies and prognosis.The common causes of IC include thromboembolism,hemodynamic insufficiency,iatrogenic factors and drug-induced.However,contrast-induced IC,especially isolated right colon ischemia is rarely reported.CASE SUMMARY A 52-year-old man was admitted to the hospital due to intermittent chest distress accompanied by palpitation.Coronary angiography was performed using 60 mL of the iodinated contrast agent iohexol(Omnipaque 300),and revealed moderate stenosis of the left anterior descending artery and right coronary artery.At 3 h post-procedure,he complained of epigastric pain without fever,diarrhea and vomiting.Vital signs remained normal.An iodixanol-enhanced abdominal computed tomography(CT)scan revealed thickening,edema of the ascending and right transverse colonic wall and inflammatory exudate,without thrombus in mesenteric arteries and veins.Following 4 days of treatment with antibiotic and supportive management,the patient had a quick and excellent recovery with disappearance of abdominal pain,normalization of leucocyte count and a significant decrease in C reactive protein.There was no recurrence of abdominal pain during the patient's two-year follow-up.CONCLUSION This case emphasizes that contrast-induced IC should be considered in the differential diagnosis of unexplained abdominal pain after a cardiovascular interventional procedure with the administration of contrast media.Timely imaging evaluation by CT and early diagnosis help to improve the prognosis of IC.

关键词： ischemic colitis Isolated right colon ischemia Contrast agent Iohexol Coronary angiography Case report

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ischemic colitis after mesotherapy combined with anti-obesity medications

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World Journal of Gastroenterology 2010年第12期16卷 1537-1540页

作者： Jong Bin Kim Won Moon Seun Ja Park Moo In Park Kyu-Jong Kim Jae Nam Lee Seong Joo Kang Lee La Jang Hee Kyung Chang Department of Internal Medicine Kosin University College of Medicine Department of Pathology Kosin University College of Medicine

Mesotherapy and anti-obesity medications are gradually gaining worldwide popularity for purposes of body contouring and weight loss.Their adverse effects are various,but there is a tendency to disregard them.ischemic colitis is one of the most common diseases associated with non-obstructive blood vessel disorders.However,there have been no case reports about the adverse effects resulting from mesotherapy only or in combination with anti-obesity medications.We report on an interesting case of ischemic colitis after mesotherapy combined with anti-obesity medications in a 39-year-old female who had no risk factors.

关键词： Mesotherapy Anti-obesity medications Adverse effects ischemic colitis

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ischemic colitis after enema administration: Incidence, timing, and clinical features

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World Journal of Gastroenterology 2020年第41期26卷 6442-6454页

作者： Yura Ahn Gil-Sun Hong Ju Hee Lee Choong Wook Lee Seon-Ok Kim Department of Radiology and Research Institute of Radiology University of Ulsan College of Medicine&Asan Medical CenterSeoul 05505South Korea Department of Clinical Epidemiology and Biostatistics Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea

BACKGROUND Enema administration is a common procedure in the emergency department(ED). However, several published case reports on enema-related ischemic colitis(IC) have raised the concerns regarding the safety of enema agents. Nevertheless, information on its true incidence and characteristics are still lacking.AIM To investigate the incidence, timing, and risk factors of IC in patients receiving enema.METHODS We consecutively collected the data of all adult patients receiving various enema administrations in the ED from January 2010 to December 2018 and identified patients confirmed with IC following enema. Of 8320 patients receiving glycerin enema, 19 diagnosed of IC were compared with an age-matched control group without IC.RESULTS The incidence of IC was 0.23% among 8320 patients receiving glycerin enema;however, there was no occurrence of IC among those who used other enema agents. The mean age ± standard deviation(SD) of patients with glycerin enemarelated IC was 70.2 ± 11.7. The mean time interval ± SD from glycerin enema administration to IC occurrence was 5.5 h ± 3.9 h(range 1-15 h). Of the 19 glycerin enema-related IC cases, 15(79.0%) were diagnosed within 8 h. The independent risk factors for glycerin-related IC were the constipation score [Odds ratio(OR), 2.0;95% confidence interval(CI): 1.1-3.5, P = 0.017] and leukocytosis(OR, 4.5;95%CI: 1.4-14.7, P = 0.012).CONCLUSION The incidence of glycerin enema-related IC was 0.23% and occurred mostly in the elderly in the early period following enema administration. Glycerin enemarelated IC was associated with the constipation score and leukocytosis.

关键词： Enema Glycerin ischemic colitis Incidence Timing Risk factors

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Natural history of inferior mesenteric arteriovenous malformation that led to ischemic colitis: A case report

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World Journal of Clinical Cases 2021年第2期9卷 396-402页

作者： Yushi Kimura Takeshi Hara Ryotaro Nagao Takayuki Nakanishi Junji Kawaguchi Atsushi Tagami Tsuneko Ikeda Hiroshi Araki Hisashi Tsurumi Department of Gastroenterology Matsunami General HospitalHashima-gun 501-6062Japan Department of Hematology Matsunami General HospitalHashima-gun 501-6062Japan Department of Pathology Matsunami General HospitalHashima-gun 501-6062Japan

BACKGROUND ischemic colitis with inferior mesenteric arteriovenous malformation(AVM)is a rare disease.Although a few reports have been published,no report has described the natural history of idiopathic mesenteric AVM.CASE SUMMARY A 50-year-old male was admitted to our hospital due to abdominal pain that had persisted for 3 mo and bloody diarrhea.He had no history of trauma or abdominal surgery.He had undergone two colonoscopies 6 mo and 2 years ago,and they showed only a polyp.He was diagnosed with ischemic colitis with inferior mesenteric AVM following contrast-enhanced abdominal computed tomography(CT)and underwent rectal low anterior resection.He has not had a recurrence of symptoms for 3 years.His history showed that he had undergone non-enhanced abdominal CT 2,5,and 8 years ago when he had attacks of urinary stones.Retrospectively,dilation of blood vessels around the rectosigmoid colon could have been detected 5 years ago,and these findings gradually became more evident.CONCLUSION This is the first report of the natural history of inferior mesenteric AVM.

关键词： Inferior mesenteric arteriovenous malformation ischemic colitis Natural history Case report Arteriovenous malformation

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ischemic bowel disease in 2021

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World Journal of Gastroenterology 2021年第29期27卷 4746-4762页

作者： Monjur Ahmed Department of Medicine Division of Gastroenterology and HepatologyThomas Jefferson UniversityPhiladelphiaPA 19107United States

ischemic bowel disease(ISBODI)includes colon ischemia,acute mesenteric ischemia(AMI)and chronic mesenteric ischemia(CMI).Epidemiologically,colon ischemia is the most common type followed by AMI and CMI.There are various risk factors for the development of ISBODI.Abdominal pain is the common presenting symptom of each type.High clinical suspicion is essential in ordering appropriate tests.Imaging studies and colonoscopy with biopsy are the main diagnostic tests.Treatment varies from conservative measures to surgical resection and revascularization.Involvement of multidisciplinary team is essential in managing ISBODI.Although open surgery with revascularization plays an important role,recently there is an increasing interest in percutaneous endovascular treatment.

关键词： Colon ischemia ischemic colitis Acute mesenteric ischemia Chronic mesenteric ischemia Endovascular treatment of acute and chronic mesenteric ischemia

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Intestinal ischemic manifestations of SARS-CoV-2:Results from the ABDOCOVID multicentre study

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World Journal of Gastroenterology 2021年第32期27卷 5448-5459页

作者： Lorenzo Norsa Pietro Andrea Bonaffini Maja Caldato Cristiana Bonifacio Aurelio Sonzogni Amedeo Indriolo Clarissa Valle Federica Furfaro Alice Bonanomi Paolo NiccolòFranco Mauro Gori Veronica Smania Lucia Scaramella Laura Forzenigo Maurizio Vecchi Monica Solbiati Giorgio Costantino Silvio Danese Lorenzo D'Antiga Sandro Sironi Luca Elli Department of Pediatric Gastroenterology Hepatology and Transplantation ASST Papa Giovanni XXIIIBergamo 24127Italy Department of Radiology Papa Giovanni XXIII Bergamo University of Milano-BicoccaMilan 20126Italy Fondazione IRCCS Ca’Granda Department of Emergency MedicineOspedale Maggiore PoliclinicoMilano 20122Italy Department of Radiology Humanitas Clinical and Research CenterIRCCSRozzano 20089Italy Department of Pathology ASST Papa Giovanni XXIIIBergamo 24127Italy Department of Gastroenterology and Endoscopy ASST Papa Giovanni XXIIIBergamo 24127Italy IBD Center Humanitas Clinical and Research Center IRCCSHumanitas UniversityRozzano 20089Italy Post-Graduate School of Diagnostic Radiology University of Milano-BicoccaMilano 20126Italy Cardiovascular Department ASST Papa Giovanni XXIIIBergamo 24127Italy Department of Gastroenterology and Endoscopy Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilano 20122Italy Department of Pathophysiology and Transplantation University of MilanMilano 20122Italy Department of Radiology Fondazione IRCCS Ca'Granda Ospedale Maggiore PoliclinicoMilano 20122Italy Fondazione IRCCS Ca’Granda Department of Emergency MedicineOspedale Maggiore PoliclinicoDepartment of Clinical Sciences and Community HealthUniversity of MilanMilano 20122Italy

BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)disease(coronavirus disease 19,COVID-19).AIM To define the clinical and histological,characteristics,as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection.METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy.Clinical,radiological,endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed.The diagnosis was established by consecutive analysis of all abdominal computed tomography(CT)scans performed.RESULTS Among 2929 patients,21(0.7%)showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization.Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12.Three patients presented thrombosis of main abdominal veins.Endoscopy,when feasible,confirmed the diagnosis(6 patients).Surgical resection was necessary in 4/21 patients.Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon.Median hospital stay was 9 d with a mortality rate of 39%.CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19.A high index of suspicion should lead to investigate this complication by CT scan,in the attempt to reduce its high mortality rate.Histology shows atypical feature of ischemia with important endotheliitis,probably linked to thrombotic microangiopathies.

关键词： Coronavirus COVID-19 ischemic colitis Small bowel ischemia Endothelial inflammation

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World Journal of Gastroenterology 2021年第42期27卷 7299-7310页

作者： Sinan Sadalla Andrea Lisotti Lorenzo Fuccio Pietro Fusaroli UnitàOperativa Complessa di Gastroenterologia e Endoscopia Digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40024Italy UnitàOperativa Complessa di Gastroenterologia e Endoscopia Digestiva Universitàdi Bologna/Ospedale di ImolaImola(BO)40026Italy Divisione di Gastroenterologia Dipartimento di Scienze Medico-Chirurgiche(DIMEC)IRCSS-Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Colonoscopy is a risk factor for colon ischemia.The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs;the etiology of colon ischemia after colonoscopy is multifactorial.The causative mechanisms include splanchnic circulation impairment,bowel preparation,drugs used for sedation,bowel wall ischemia due to insufflation/barotrauma,and introduction of the endoscope.Gastroenterologists must be aware of this condition and its risk factors for risk minimization,early diagnosis,and proper treatment.

关键词： Endoscopy Colon ischemia Colonoscopy Bowel preparation Mesenteric circulation ischemic colitis

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