What does an ischemic injury pattern on the rectum in a colonoscopy indicate?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am reviewing your case history and attached laboratory investigations and will get back to you shortly.

Thanks and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have reviewed your case history and attached laboratory investigations (attachment removed to protect the patient's identity).

1. You are having two clinically important symptoms, one is severe abdominal pain, and the other is per rectal bleeding.

2. On your biopsy report,

a. There was nothing remarkable on upper GI (gastrointestinal) endoscopy. Biopsies were normal.

b. On colonoscopy, terminal ileum and right-sided colon biopsies are normal too.

c. They removed hyperplasia polyps, but they do not explain your pain.

d. Rectum showed an ischemic pattern of injury, which is not of concern.

3. Rectal ischemic injury pattern can explain your severe abdominal pain and per rectal bleeding, which should be taken care of.

4. Underlying reasons can be compromised blood supply to rectal mucosa, sometimes in a hypercoagulable state (if blood is relatively thick). There are other reasons, like narrowing of blood vessels, but that is mostly in the elderly, not at the age of 26. Infections or abdominal trauma are rare possibilities if you have any such history.

5. Your CT (computed tomography) scan report is important to review any surrounding changes other than colon wall thickening.

6. Were you on any oral contraceptives, which sometimes cause blood thickening?

Your doctor will likely go for further workup in your case because, at this age, severe abdominal pain and per rectal bleeding cannot be just symptomatically managed. Finding out the cause is important, like a hypercoagulable workup. If you can, reattach the first two reports, especially if you have colonoscopy images (rectal mucosa image) and a CT scan report.

Hope this helps.

Thanks and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have reviewed your case history and attached laboratory investigations (attachment removed to protect the patient's identity).

My opinion,

1. Your metabolic profile, including your liver functions, kidney functions, and electrolytes, were normal on reports.

2. Your complete blood profile suggests low hemoglobin, likely because of your history of per rectal bleeding and black stools.

3. Your upper endoscopy report and biopsy are grossly unremarkable, not explaining your symptoms.

4. I have seen your colonoscopy images, there was some mucosal thickening and red spots on the rectal mucosa, and the biopsy was suggestive of ischemic etiology.

5. A few polyps were removed, and I have seen their biopsy reports as well. However, again this does not explain the severity of the pain in your case.

You should be further evaluated regarding your symptoms, autoimmune profile, hypercoagulable workup, and abdominal vasculature evaluation. Black tarry stools can be because of some bleeding in the gastrointestinal tract. Your consultation endoscopy and colonoscopy have already been done. However, if this is persistent, you will need further evaluation in terms of either enteroscopy or capsule endoscopy for a full small bowel evaluation. Stool tests like stool DR (detailed report) will also help to rule out any infective etiology and physically to examine your stools. Meanwhile, you can use anti-spasmodic medicine like Mebeverine or Drotaverine for abdominal pain. However, please consult a physician, discuss with them, and start taking the medications with their consent.

Hope this helps.

Thanks and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

1. There is mucosal inflammation isolated to the rectum only, and biopsy suggests an ischemic injury pattern behind this inflammation. This can be caused by compromised blood flow to this part of the colon for a while. Now it is important to find out the cause behind that. I already mentioned previously that we do certain tests to check further if your blood is unusually thick or if there are any vascular problems behind this. I suggested this workup or further evaluation because your abdominal pain is out of proportion to these isolated colon findings, and you also had a history of per rectal bleeding.

2. Your remaining colon and upper endoscopy were normal.

3. This is not Crohn's. There was a possibility of ulcerative colitis, but after the biopsy report, it was ruled out because ulcerative colitis has typical features on biopsy, and biopsy is the best test for its diagnosis. This is also not cancer.

4. I do not think that it is chronic. This seems to be an acute problem.

Were you on any oral contraceptives or medicine that can provoke the thickening of blood or blood clot formation? Please answer this question.

Hope this helps.

Thanks and take care.