Introduction. Ischemic colitis develops due to acute reduced blood flow through the colon and appearance of secondary reperfusion injuries. Patients dependent on renal replacement therapies are at highest risk because of frequent periods of hypotension and hypoperfusion, related to haemodialysis.
Case presentation. A 66-year-old female patient, with history of stage 4 chronic kidney disease (CKD), presented for haemorrhagic shock following occult gastrointestinal bleeding and secondary acute posthaemorrhagic anaemia. Because of multiple systemic dysfunctions, she was admitted into the intensive care unit (ICU). Continuous renal replacement therapy with cytokine filter was performed, to reduce the level of circulating inflammatory markers. A computed tomography examination was performed, that established the diagnosis of ischemic colitis and she underwent subtotal colectomy with terminal ileostomy. The evolution was favourable, and after 10 days she was transferred from the ICU to the surgical ward. After another 5 days, she returned to the previous functional status and was discharged.
Conclusions. Ischemic colitis can lead to lower gastrointestinal bleeding and even to haemorrhagic shock, especially in patients with chronic kidney disease, intermittent hemodialysis, atherosclerotic diseases, heart failure and diabetes mellitus.
Keywords: ischemic colitis, chronic renal failure, reperfusion, hypotension, shock.
Tiberiu P. NEAGU
Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, Romania
Address: Calea Floreasca Street 8, 01446 Bucharest, Romania
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