A Case of Gangrenous Ischemic Colitis -Speculation of the Mechanism behind Elevated Serum CEA-

Takashi Sakurai, Hideki Tatematsu, Kouichi Yamataka, Takaaki Yamamoto, Yoshito Arisawa and Hideyuki Kawahara

Division of Surgery, Kawasaki Municipal Ida Hospital

An 84-year-old woman admitted on February 14, 2002, for abdominal pain, vomiting, diarrhea, and hematochezia. She had a history of hypertension, ischemic heart disease, and diabetes mellitus. We detected Escherichia coli O-1 in her stool. Abdominal computed tomography and colorectal endoscopy showed severe inflammation and necrosis of the descending colon, leading to a diagnosis of gangrenous ischemic colitis induced by bacterial enterocolitis dehydration. Laboratory data showed elevated serum CEA at 106.1ng/ml. We suspected a malignany, but found no obvious disease, and her CEA returned to the normal range 26 days later at >5.0ng/ml.
Descending colectomy and temporarlly transverse colostomy were done on March 13. Resected specimens showed no malignancy and normal CEA localization with immunohistochemical staining. Only 1 case of ischemic colitis with elevated CEA has been reported to our knowledge. The mechanism behind elevated serum CEA is unknown, but we surmise possible activation of CEA synthesis by prior bacterial enterocolitis or the collection of stool in the retroperitoneal space.

Key words
ischemic colitis, carcinoembryonic antigen, bacterial enterocolitis

Reprint requests
Takashi Sakurai Division of Surgery, Kawasaki Municipal Ida Hospital 2-27-1 Ida, Nakahara-ku, Kawasaki-city, 211-0035 JAPAN

Accepted
November 27, 2002

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