Three Cases of Gangrenous Type Ischemic Colitis with Intriguing Endoscopic Findings

Masahiko Murakami, Yoshinori Shimizu, Yoshihiro Fukoue, Kazuo Suzuki, Mitsuo Kusano, Sadatsugu Aida*, Hiroshi Arai*, Ugen Ree*

Department of Surgery, Showa University of Medicine
*Department of Surgery, Shiroyama Hospital

We report here three cases of gangrenous ischemic colitis with characteristic endoscopic findings. Case 1 was an 84-year-old man, case 2, a 77-year-old, woman, and case 3, a 59-year-old man. All patients had melena as a initial symptom and few abdominal findings. Endoscopy performed within 12 hours after the onset revealed extensive and circumferential multiple submucosal hematomas. One patient (case 1) died of MOF 5 days later. The other two patients (cases 2 and 3) underwent emergency laparotomy for stimulation symptoms of the peritoneum after a stable condition of 5 to 7 days, but one patient (case 2) died of MOF. Ablation of the mucosa was extensive on the regions of the isolated colon where the above-mentioned findings were endoscopically confirmed. These results indicated that circumferential multiple submucosal hematomas were previously suggestive of ablation of the mucosa and that the extent could be a factor indicating surgical treatment.

Key words
gangrenous type ischemic colitis, endoscopic features in ischemic colitis, multiple sub mucosal hematoma

Reprint requests
Masahiko Murakami Department of Surgery, Showa University of Medicine
1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142 JAPAN

Accepted
January 11, 1995

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