Ischemic colitis masquerading as colonic tumor:Case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.

Lubiprostone induced ischemic colitis

Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.

Lower body weight and female gender:Hyperphosphatemia risk factors after sodium phosphate preparations

Casais et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g.Our group has already described the relationship between body weight and hyperphosphatemia with these preparations,although our study was not quoted by Casais.We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight:group Ⅰconsisting of seven women with a median weight of 60 kg and group Ⅱconsisting of five men and one woman with a median weight of 119.2 kg.Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight,fluid intake and total body weight.Our study demonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia.In the study by Casais et al,66% of the study subjects were women,the correlation between serum phosphate and gender in their data also appears to be important.Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate.Decreased volume of distribution in women is due to diminished body weight.This is further compounded by decreased creatinine clearance in females.

Radiographical evaluation of ulcerative colitis

Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis(UC).Imaging can be used non-invasively to determine the extent of involvement,severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease(IBD)manifestations.While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings,the use of computed tomography enterography(CTE)or magnetic resonance enterography(MRE)are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation.Additionally,CT colonography and MR colonography are emerging techniques with potential applications in UC.Ultrasonography,leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations.This plethora of radiological imaging options has become a vital component of UC assessments.

回肠储袋肛管吻合术后储袋扭转:对其发生率、诊断和治疗结局的系统综述

背景:结直肠切除加回肠储袋肛管吻合术(IPAA)是难治性溃疡性结肠炎和家族性腺瘤性息肉病的标准外科术式。然而,储袋扭转时有发生,尽管发生率很低。本研究旨在探讨IPAA患者术后储袋扭转的发生率、临床表现和治疗。方法:于2018年8月10日通过医学文献图书馆系统检索已发表的文献,由两名独立的研究人员分别进行文献筛选、数据提取、方法学质量评估。同时,检索美国Mayo Clinic 2008年1月至2018年8月间的电子病历发现了1例储袋扭转病例。结果:一项报道了IPAA长期结局的大样本研究显示,储袋扭转发生率为0.18%(3/1700)。本研究共纳入22例储袋扭转患者进行分析,其中18例原发疾病为溃疡性结肠炎。全组病例中位年龄32岁,女性占73%。IPAA术后出现储袋扭转的中位时间为36个月,出现首发症状至诊断储袋扭转的中位时间为24小时。腹痛是最常报道的症状(76%)。多数病例是经腹部CT作出初步诊断(76%,13/17)。11例患者行内镜治疗,仅1例(9%)成功。20例患者行手术治疗,最常采用的手术方式是储袋固定术和储袋切除术。5例(25%)患者接受了再次IPAA手术。结论:储袋扭转是IPAA术后一种罕见但严重的并发症,出现梗阻症状时应考虑储袋扭转的可能。内镜治疗成功率非常低;如果能早期诊断、早期手术,手术治疗疗效确切。