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An 81-year-old woman presented with sudden abdominal cramp-like pain with bloody diarrhoea for 4 h before admission. She had suffered three episodes of watery diarrhoea, followed by bright red stools after finishing dinner. Vital signs and cardiopulmonary conditions were within normal limits, with no orthostatic hypotension. Mild tenderness over the right lower quadrant was noted. Initial laboratory findings were normal except for serum creatinine level, which was 1.56 mg/dL. The patient had no history of radiation exposure. Colonoscopy was performed within 6 h after her arrival because of the active bleeding. The study revealed ‘colonic single-strip sign’—a linear ulcer running longitudinally, commonly found along the antimesenteric colonic wall at the sigmoid colon—suggestive of ischaemic colitis (figure 1).1 2 The histological finding of ischaemic colitis is focal crypt dropout in the early stage (figure 2). Advanced ischaemia shows epithelial loss, presence of acute and chronic inflammatory cells, and submucosal congestion (figure 3). To confirm diagnosis, careful biopsy was performed before terminating the session, to prevent complication. CT performed later revealed bowel wall thickening, thumb printing and pericolonic stranding of the area supplied by the inferior mesenteric artery (figures 4 and and5).5). Potential infectious causes were ruled out based on negative findings for Clostridium difficile toxins A and B in stool, as well as negative stool, urine and blood culture. A non-operative approach was used, with successful reversion to a more normal colon.3
The authors would like to thank Dr Samornmas Kanngurn for the pathological findings.
Contributors: OT was the primary physician, made the diagnosis, managed the case and prepared the first draft of the manuscript. KP contributed to the concept, and helped to draft and revise the manuscript.
Competing interests: None declared.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.