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BMJ Case Rep. 2015; 2015: bcr2014207049.
Published online 2015 September 16. doi:  10.1136/bcr-2014-207049
PMCID: PMC4577707

Colonic single-stripe sign


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

Figure 1
Colonic single-stripe sign.
Figure 2
Detached mucosa and focal crypt dropout in early stage.
Figure 3
Epithelial loss, acute and chronic inflammatory cells, and submucosal congestion.
Figure 4
Bowel wall thickening, thumb printing and pericolonic stranding (lateral).
Figure 5
Bowel wall thickening, thumb printing and pericolonic stranding (axial).

Learning points

  • A colonic single-stripe sign is the typical colonoscopic finding of ischaemic colitis.
  • Ischaemic colitis can be managed using a non-operative approach.
  • Biopsy should be carefully performed to confirm the diagnosis.


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.


1. Green BT, Tendler DA Ischemic colitis: a clinical review. South Med J 2005;98:217–22. doi:10.1097/01.SMJ.0000145399.35851.10 [PubMed]
2. Zuckerman GR, Prakash C, Merriman RB et al. The colon single-stripe sign and its relationship to ischemic colitis. Am J Gastroenterol 2003;98:2018–22. doi:10.1111/j.1572-0241.2003.07633.x [PubMed]
3. Elder K, Lashner BA, Al Solaiman F Clinical approach to colonic ischemia. Cleve Clin J Med 2009;76:401–9. doi:10.3949/ccjm.76a.08089 [PubMed]

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