Ischemic colitis is a condition characterized by inflammation and injury to the colon due to insufficient blood supply, typically resulting from reduced blood flow to the intestines. It has been recognized as a complication of COVID-19 infection, although understanding of its underlying mechanisms remains limited.
Two cases of ischemic colitis associated with COVID-19 infection are presented, highlighting the challenge of recognizing and managing this manifestation of the disease.
Case 1 describes a 62-year-old man with a history of hypertension, type 2 diabetes, and gastroesophageal reflux disease who presented to the hospital with multiple episodes of hematochezia (bloody stools) over one day. Despite being hemodynamically stable and afebrile, he had mild left lower abdominal tenderness. Laboratory tests showed elevated white blood cell count (WBC) and lactic acid levels, along with positive SARS-CoV-2 PCR test results. Imaging revealed inflammatory changes in the colon, and flexible sigmoidoscopy confirmed severely inflamed and ulcerated mucosa extending from the rectum to the splenic flexure. Biopsies confirmed ischemic colitis, and the patient was treated with intravenous antibiotics before being discharged on the third day following resolution of symptoms.
Case 2 features a 66-year-old woman with well-controlled type 2 diabetes and hyperlipidemia who presented to the hospital with left lower abdominal pain, intermittent hematochezia (bloody stools), and nonbloody emesis over two days. She had previously tested positive for asymptomatic COVID-19 infection three weeks before her presentation. Despite being afebrile and hemodynamically stable, she exhibited mild left lower abdominal tenderness. Laboratory tests showed normal hemoglobin and hematocrit levels, along with elevated lactic acid. Imaging revealed inflammatory changes in the colon extending from the hepatic flexure to the sigmoid, and flexible sigmoidoscopy confirmed ulcerations and inflammation involving the sigmoid and descending colon. Biopsies confirmed ischemic colitis, and the patient was treated with antibiotics before being discharged on the fourth day after symptom resolution.
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