Bleeding due to colorectal atheroembolism. Diagnosis by biopsy of adenomatous polyps or of ischemic ulcer.
ABSTRACT Atheroembolism, although not infrequent at autopsy, is seldom identified in life, when it may present as a multisystem disease involving lower limbs, kidney, and gastrointestinal (GI) tract. Diagnosis of isolated GI involvement usually requires examination of surgically resected tissue, because recognition by endoscopic GI biopsy is exceptional. We diagnosed colorectal atheroembolism by biopsy in four patients. All were elderly (68-80 years old) and had generalized atheroma, including aortic aneurysms. Three patients had sudden onset of frank rectal bleeding with clots or bloody diarrhea, lower abdominal discomfort, and tenderness. Biopsy revealed atheroemboli in a rectal ischemic ulcer and in colorectal adenomatous polyps. In all three, disease resolved on conservative management and did not recur during the period of follow-up. In the fourth patient, asymptomatic atheroembolism was identified in an adenomatous polyp at the splenic flexure. Extraintestinal disease attributable to atheroembolism was not present in any of the patients. Atheroembolism with manifestations confined to the colon may sometimes be diagnosed by biopsy, appears to be more frequent than currently recognized, and may present a diagnostic challenge as a self-limited episode of rectal bleeding.
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ABSTRACT: The endoscopic features of cholesterol atheroembolism affecting the colon have not been extensively described in the literature, owing to the rarity of this entity. We report a middle-aged man who presented with hematochezia after recent coronary artery bypass graft surgery. Colonoscopy revealed ulcerative skip lesions with overlying slough resembling pseudomembranes distal to the transverse colon, inconsistent with the initial clinical impression of ischemic colitis. As a consequence of continued bleeding with hemodynamic instability, the patient underwent an extended low anterior resection with end transverse colostomy. Histology revealed cholesterol atheroembolism resulting in patchy ischemic ulceration of the colon. Colonic cholesterol atheroembolism can mimic the endoscopic features of pseudomembranous colitis.Surgical laparoscopy, endoscopy & percutaneous techniques 01/2009; 18(6):616-8. DOI:10.1097/SLE.0b013e318180c956 · 0.94 Impact Factor
Digestive Diseases and Sciences 04/1995; 40(3):481-4. DOI:10.1007/BF02064354 · 2.55 Impact Factor
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ABSTRACT: Aim: Ischemic colitis (IC) is generally considered a disease of elderly patients who have associated diseases. It is classified into the non-gangrenous type, and gangrenous type. The aim of this study is to re-evaluate the clinical, endoscopic and histological features of IC in the Greek population. Methodology: We retrospectively analyzed the clinical characteristics, endoscopic and histologic findings in 254 patients (110 men and 144 women) with IC, diagnosed by early endoscopy or surgical management. Results: In non-gangrenous type (percentage: 84%) (127 women, 87 men), the patientságe range was from 22 to 96 years (mean: 67 years), and 19/214 patients (8.8%) were less than 50 years of age. The clinical features were: melena (54%), abdominal pain (14%) and bloody diarrhea (10%), and the early endoscopy (n=118) showed edema and focal hemorrhage of mucosa (31%). The histological findings were: mucosal atrophy, edema, hyperemia and mild acute inflammation). In gangrenous type (percentage: 16%) (17 women, 23 men), the patients age range was from 57 to 89 years (mean: 73 years), and none of the patients were less than 50 years of age. The main symptom was acute abdominal pain (60%), and the histology showed acute ischemic necrosis of the bowel wall in the whole population (100%). Conclusion: IC is a rare disease in the Greek population. The gangrenous type presents only in older patients (>50 years). The non-gangrenous type presents also in younger patients, especially females, and early endoscopy is essential for the accurate diagnosis of disease.