SEGMENTAL ISCHEMIC COLITIS IN THROMBOSING LYMPHOCYTIC VENULITIS

This case illustrates the difficulty of diagnosing a colonic stenosis of ischemic origine. A 70-year-old lady presents with abdominal pain, fever and melaena. Lc are 15.2, ESR 39 mm, CEA 2.7 ng/ml. A barium ene ma shows a stenosis of the transverse colon that is suspicious of neop lasia. At time of operation, an induration of the transverse colon is found with edema of the corresponding mescolon but no tumour is palpat ed. A resection of this area is performed and an end to end anastomosi s performed. Pathology shows an ischemic colitis secondary to a lympho cytic thrombotic venulitis. The patient is discharged home one month p ostoperatively. 4 weeks later she is readmitted with the same symptoms . A gastrograffin enema shows a similar stenosis in the transverse col on including the anastomosis. The diagnosis is made of a recurrent isc hemic stenosis. The patient improves over a 10-day period of conservat ive treatment (anticoagulation, TPN, steroids). A control barium enema shows a near resolution of the stenosis. The majority of ischemic col itis are of arterial origin nevertheless ischemis colitis of venous or igin exists. The factor causing venous ischemia are not known. It is t hough thought to be associated with hypersensitivity vasculitis of dru g origin. Its initial diagnosis versus neoplasia is difficult but once made there is a good response to a conservative treatment.