P1677 - Ischemic Colitis in a Patient With Sickle Cell Disease: Diagnostic Challenges and Management

Hira Imran, MD¹, Jordan L.. Redfield, MD², Dawit Jowhar, MD, PhD², Leonard K. Baidoo, MD^3
1University of Tennessee, Memphis, TN; ²University of Tennessee Health Science Center, Memphis, TN; ³University of Tennessee College of Medicine, Memphis, TN

Introduction: Ischemic colitis is the most common form of gastrointestinal ischemia, predominantly affecting elderly patients due to hypotension and thromboembolic events. However, ischemic colitis can also occur in young patients with sickle cell disease (SCD) due to vaso-occlusion. Sickle cell-induced ischemic colitis is a rare phenomenon, and accurate diagnosis can be challenging. This abstract presents a case of ischemic colitis in a patient with SCD, highlighting the diagnostic challenges encountered and the successful management strategies employed.

Case Description/Methods: A 30-year-old male with SCD, on hydroxyurea and crizanlizumab therapy, presented with abdominal pain, watery diarrhea, and hematochezia. Initial evaluations suggested an infectious or inflammatory etiology, with ischemic colitis considered less likely. However, further investigations, including colonoscopy and biopsies, confirmed the diagnosis of ischemic colitis.

Discussion: Sickle cell-induced ischemic colitis is a rare condition, and accurate diagnosis can be challenging due to the various etiologies of abdominal pain in SCD patients. Ischemia/hypoxia leading to a mismatch in blood supply and demand is the underlying mechanism. Diagnosis requires a high index of suspicion, and prompt initiation of medical management is crucial. Confirmatory colonoscopy and biopsy may be challenging in hospitals without endoscopy capabilities, leading to delays in appropriate management.


Disclosures:


Hira Imran, MD¹, Jordan L.. Redfield, MD², Dawit Jowhar, MD, PhD², Leonard K. Baidoo, MD³. P1677 - Ischemic Colitis in a Patient With Sickle Cell Disease: Diagnostic Challenges and Management, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.