Saif Bella, MD1, Md S. Alom, MD2, Leslie Bank, MD1
1United Health Services Wilson Hospital, Johnson City, NY; 2United Health Services, Johnson City, NY
Introduction: Ischemic colitis remains an enigmatic disease with a wide array of pathogenic mechanisms and variable outcome. Recent series indicate that right-sided ischemic colitis (RIC) may have a worse prognosis compared to left-sided colitis (LIC). We are presenting two interesting cases of RIC believed to be colon cancer.
Case Description/Methods: 1st case: An 82-year-old Caucasian female who has a pertinent medical history of hypertension, GERD, dyslipidemia, and gout. She presented with right lower quadrant abdominal pain. The pain was followed by a loose non-bloody bowel movement. Her symptoms were associated with tiredness, nausea, subjective fever, and chills. She had normal hemodynamics upon presentation. Her exam was benign except for RLQ fullness. Initial blood work was consistent Leukocytosis. CT scan of the abdomen and pelvis mass like thickening of the proximal right colon which was concerning for colonic neoplasm (image 1). CEA was within normal. Fecal calprotectin level was increased at 309. Stool studies were negative for enteric pathogens or C. difficile infection. Colonoscopy demonstrated an area of moderately congested and ulcerated mucosa in the ascending colon and cecum. These findings were suspicious for ischemic colitis. Biopsies confirmed ischemic colitis and ruled out dysplasia or malignancy. She was treated successfully with intravenous fluids, bowel rest regimen, and IV antibiotics.
2nd case: A 70-year-old male who underwent CABG for underlying CAD. Postoperatively, he complained of right lower quadrant abdominal pain. CT scan of the abdomen and pelvis showed Cecal mass concerning for colon cancer (image 2). Colonoscopy revealed findings consistent with ischemic colitis (Image 3). patient treated with IV fluid and Antibiotics. He did well. 8 months later, colonoscopy was repeated and showed complete resolution of his colitis.
Discussion: RIC differs from left-sided ischemic colitis. RIC diagnosis could be challenging. Most common reported presentations were weight loss, diarrhea, vomiting or ileus, and no rectal bleeding. We are presenting rare cases of RIC misdiagnosed initially as colon cancer.
Citation: Saif Bella, MD; Md S. Alom, MD; Leslie Bank, MD. P1096 - RIGHT SIDE ISCHEMIC COLITIS OR COLON CANCER: CASE REPORTS. Program No. P1096. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.