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Session: ePoster Monitor 1-Benign Abdominal Disease 1

eP105 - Mass-Forming Ischemic Colitis - A Clinical Challenge

Sunday, June 2, 2024
8:24 AM – 8:29 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Nicholas S. Cairl, MD

    Resident
    Trinity Health Ann Arbor
    Ypsilanti, MI, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Robert K. Cleary, MD

    Program Director Colon and Rectal Surgery
    Trinity Health Ann Arbor
    Trinity Health
    Ann Arbor, Michigan, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no relevant relationships with ineligible companies.

Purpose/Background: A woman in her 70s with a history of congestive heart failure, type 2 diabetes, prior open aortic aneurysm repair, lymphoma and breast cancer presented to the emergency department with several days of sharp abdominal pain. On physical exam, she was noted to have a large ventral hernia and was tender to palpation in the right lower quadrant. Labs were notable for a leukocytosis of 14 K/uL. Imaging demonstrated abnormal mucosal thickening of the mid-ascending colon with pericolonic fat stranding concerning for colitis versus mass and multiple abdominal wall hernias.Methods/Interventions: The patient underwent colonoscopy that revealed a large, ulcerated, non-obstructing mass at the proximal ascending colon. Biopsies were taken and returned showing ulceration with focal ischemic changes. Given her persistent pain she was offered intervention and underwent a right colectomy with concomitant ventral hernia repair.Results/Outcomes: She tolerated the procedure well and was discharged on post-operative day 6 after an uncomplicated hospital course. Final pathology revealed ulceration and granulation tissue with mass-like scar extending into the subserosa.Conclusion/

Discussion: Mass-forming ischemic colitis represents a unique diagnostic challenge. It is often found in the ascending colon and its appearance on both imaging and endoscopy is similar to that of colonic malignancy. While biopsies may return without evidence of neoplasia, patients and surgeons alike may not feel comfortable excluding malignancy entirely due to the possibility of incomplete sampling. Monitoring the mass with serial colonoscopies is an option; however, repeated bowel preparation and the time commitment associated with multiple colonoscopies poses a burden to the patient. This may be a viable treatment route for patients unfit for surgical intervention, but for otherwise healthy patients, colectomy allows for diagnostic certainty and faster resolution of symptoms, albeit with the risks associated with surgery. In patients presenting with the mass-forming variant of ischemic colitis, surgeons should take into account the patient’s symptomatology and functional status and engage in shared decision making with the patient to determine the best course of treatment.Cecal massAxial imaging demonstrating circumferential thickening of the cecum