Article
Ischemic Colitis: A Case Study Highlighting A Unique Association: 1121
The American Journal of Gastroenterology
(2012)
Abstract
Purpose: A 27-year-old male with no significant medical history presented with a two-day history of lower abdominal pain and hematochezia. Abdominal pain was characterized as cramping and located in the bilateral lower quadrants. Pain was associated with a large, bloody bowel movement and patient denied any other associated symptoms. On physical exam, patient was tachycardic and abdomen was tender diffusely with voluntary guarding. Lab work was significant only for a leukocytosis of 13. CT A/P w/ contrast illustrated diffuse bowel wall thickening from the mid- transverse colon to the distal sigmoid colon and possibly involving the rectum. The descending colon was well circumscribed and demonstrated loss of haustration with concordant target sign. Pericolonic fat stranding was seen in the region of the splenic flexure and proximal descending colon. Colonoscopy revealed discontinuous areas of polypoid, cobblestoned, nonbleeding serpintine ulcerated mucosa in the transverse colon. An area of mucosa in the terminal ileum was nodular. Based on the radiologic and colonoscopy findings, a presumptive diagnosis of IBD was made while we awaited biopsy results. Colonoscopic biopsies were significant for necrosis of superficial mucosal layer with relative sparing of the deeper portion. The lamina propria in the involved areas appeared hyalinized with hemorrhage - findings all characteristic of ischemic colitis. History taking had also revealed a 5 month history of taking Adderall and urine toxicology also confirmed amphetamine usage. Ischemic colitis is a common cause of lower gastrointestinal bleeding leading to approximately 10% to 19% of hospital admissions. Most patients with colon ischemia are older with atherosclerotic disease or diabetes mellitus. Several conditions, as well as a wide variety of medications, are known to predispose to colonic ischemia. Many of these medications are under-recognized. Adderall is a prescription stimulant which has gained popularity for labeled or unlabeled use among the younger population. We report a case of ischemic colitis in a young patient linked to the use of Adderall. Adderall consists of a mixture of dextroamphetamine and amphetamine salts and is a prescription drug for attention deficit/hyperactivity disorder (ADHD) and narcolepsy. The association of ischemic colitis with dextroamphetamine has only been documented in the literature in one published case report from 1991. This case illustrates the potential for severe vascular ischemia with use of prescription stimulants such as Adderall. It also highlights the value of a complete history in young patients presenting with colitis.
Disciplines
Publication Date
October 1, 2012
DOI
10.14309/00000434-201210001-01121
Citation Information
McGaw, Camille MD; John, Bijo MD; Kermanshahi, Taher Reza MD; Munoz, Juan MD Ischemic Colitis: A Case Study Highlighting A Unique Association, American Journal of Gastroenterology: October 2012 - Volume 107 - Issue - p S449-S450