Acute Ischemic Colitis with Early Phase Formation of a Large Bowel Cast, Report of a Case Masato Matsumura 1 , Yoshihiko Iizuka 1 , Nobuhisa Yonemitsu 2 1Department of Gastroenterology, Sasebo Central Hospital 2Department of pathology, Sasebo Central Hospital Keyword: bowel cast , 虚血性腸炎 pp.1326-1332
Published Date 2005/8/25
DOI https://doi.org/10.11477/mf.1403100157
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A 66-year-old woman presented lower abdominal distension and hematochezia on December 4. 2002. Colonoscopy showed severe stenosis with edema and hematoma in the proximal sigmoid-colon. Irrigography revealed a stripe 7 cm in length in the stenotic lumen. Inflow of contrast medium was unable to be brought about from the anal side into the stenotic colon. The patient underwent sigmoidectomy to remove the ileus. The resected colon revealed erosion with detachment of mucosa forming two stripes, which were milky-white in color and 7 cm in length. These desquamated sections of mucosae had continuity with the non-ischemic mucosa of the anal side and floated in the stenotic lumen. Histologically, the desquamated mucosal tissues were necrotic with remnants of glandular structures and edema. The submucosal layer was edematous with mild acute inflammatory infiltration. No granulomatous lesions or vasculitis were observed. The pathological diagnosis of this condition was acute segmental ischemic colitis with formation of a large bowel casts. Only twelve cases of such a bowel cast have been reported, but this is the first case to elucidate the early phase of large bowel cast formation. Large bowel cast should be considered one of the causes of intestinal stenosis and obstruction.

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