<p>Sir,</p> <p>I would like to present the first case of ischemic colitis following colonoscopy in a patient with irritable bowel syndrome (IBS). In 2011, a 56-year-old woman was admitted with a 2-year history of recurrent abdominal pain and diarrhea with no systemic diseases. She was diagnosed with IBS after a 10-min colonoscopy (0.5 mg atropine, intramuscularly; no sedation). Three hours later, she developed continuous left lower abdominal pain with tenderness, guarding, and rebound and fresh rectal bleeding. Abdominal X-rays showed no free air in the subdiaphragmatic space. Colonoscopy showed severe diffuse mucosal inflammation of the sigmoid colon suggestive of ischemic colitis. Angiography revealed a normal inferior mesenteric artery. Her condition improved over a few days with conservative treatment. One month later, a colonoscopy showed normal colonic mucosa. The precipitating factors for ischemic colitis following colonoscopy include connective tissue disease or technical difficulties <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>that disrupt small vessel circulation of the large bowel. Our patient was very anxious prior to and during the procedure. We postulate that this psychological stress precipitated the ischemia. Decreased intravascular volume resulting from fasting and colonic preparation <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>may have been a contributory factor. To alleviate colonoscopy-related anxiety, some patients should be counseled before the procedure and perhaps a light sedation to manage pain and stress during the procedure.</p> <p>I hope you can share your advanced experience with us.</p> <p>Yours sincerely,</p> <p>Qiang Zhan</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Wheeldon</surname> <given-names>NM</given-names> </name> <name> <surname>Grundman</surname> <given-names>MJ</given-names> </name> </person-group> <article-title>Ischaemic colitis as a complication of colonoscopy</article-title> <source>BMJ</source> <year>1990</year> <volume>301</volume> <fpage>1080</fpage> <lpage>1</lpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Church</surname> <given-names>JM</given-names> </name> </person-group> <article-title>Ischemic colitis complicating flexible endoscopy in a patient with connective tissue disease</article-title> <source>Gastrointest Endosc</source> <year>1995</year> <volume>41</volume> <fpage>181</fpage> <lpage>2</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Arhan</surname> <given-names>M</given-names> </name> <name> <surname>Onal</surname> <given-names>IK</given-names> </name> <name> <surname>Odemis</surname> <given-names>B</given-names> </name> <name> <surname>Ibiº</surname> <given-names>M</given-names> </name> <name> <surname>Saºmaz</surname> <given-names>N</given-names> </name> </person-group> <article-title>Colonoscopy-induced ischemic colitis in a young patient with no risk factor</article-title> <source>Am J Gastroenterol</source> <year>2009</year> <volume>104</volume> <fpage>250</fpage> <lpage>1</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>

JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-18-1117

24523808

Letter to Editor

Ischemic colitis resulting from colonoscopy in a patient with irritable bowel syndrome

Zhan

Qiang

Guomin

Xie

Zhenxiong

Wuxi People′s Hospital Affiliated to Nanjing Medical University, Wuxi City, Jiangsu Province, China Wuxi People′s Hospital Affiliated to Nanjing Medical University, Wuxi City, Jiangsu Province, China Wuxi People′s Hospital Affiliated to Nanjing Medical University, Wuxi City, Jiangsu Province, China

Address for correspondence:Qiang Zhan, Wuxi People′s Hospital, 299 Qingyang Road, Wuxi City, Jiangsu Province, China, 214039, China zhanq33@163.com

December 2013

18 12 1117 1117

2013

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>I would like to present the first case of ischemic colitis following colonoscopy in a patient with irritable bowel syndrome (IBS). In 2011, a 56-year-old woman was admitted with a 2-year history of recurrent abdominal pain and diarrhea with no systemic diseases. She was diagnosed with IBS after a 10-min colonoscopy (0.5 mg atropine, intramuscularly; no sedation). Three hours later, she developed continuous left lower abdominal pain with tenderness, guarding, and rebound and fresh rectal bleeding. Abdominal X-rays showed no free air in the subdiaphragmatic space. Colonoscopy showed severe diffuse mucosal inflammation of the sigmoid colon suggestive of ischemic colitis. Angiography revealed a normal inferior mesenteric artery. Her condition improved over a few days with conservative treatment. One month later, a colonoscopy showed normal colonic mucosa. The precipitating factors for ischemic colitis following colonoscopy include connective tissue disease or technical difficulties <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>that disrupt small vessel circulation of the large bowel. Our patient was very anxious prior to and during the procedure. We postulate that this psychological stress precipitated the ischemia. Decreased intravascular volume resulting from fasting and colonic preparation <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>may have been a contributory factor. To alleviate colonoscopy-related anxiety, some patients should be counseled before the procedure and perhaps a light sedation to manage pain and stress during the procedure.</p> <p>I hope you can share your advanced experience with us.</p> <p>Yours sincerely,</p> <p>Qiang Zhan</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Wheeldon</surname> <given-names>NM</given-names> </name> <name> <surname>Grundman</surname> <given-names>MJ</given-names> </name> </person-group> <article-title>Ischaemic colitis as a complication of colonoscopy</article-title> <source>BMJ</source> <year>1990</year> <volume>301</volume> <fpage>1080</fpage> <lpage>1</lpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Church</surname> <given-names>JM</given-names> </name> </person-group> <article-title>Ischemic colitis complicating flexible endoscopy in a patient with connective tissue disease</article-title> <source>Gastrointest Endosc</source> <year>1995</year> <volume>41</volume> <fpage>181</fpage> <lpage>2</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Arhan</surname> <given-names>M</given-names> </name> <name> <surname>Onal</surname> <given-names>IK</given-names> </name> <name> <surname>Odemis</surname> <given-names>B</given-names> </name> <name> <surname>Ibiº</surname> <given-names>M</given-names> </name> <name> <surname>Saºmaz</surname> <given-names>N</given-names> </name> </person-group> <article-title>Colonoscopy-induced ischemic colitis in a young patient with no risk factor</article-title> <source>Am J Gastroenterol</source> <year>2009</year> <volume>104</volume> <fpage>250</fpage> <lpage>1</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>