Ischemic colitis in a young athlete?

We are familiar with the risk of ischemic colitis in elderly patients with a significant drop in blood pressure, but what about a 21-year-old athlete?

I want to share the case of a 21-year-old man with no medical history who experienced sudden-onset blood in the stool and abdominal pain after playing a 90-minute collegiate soccer match. The medical evaluation revealed signs of acute kidney injury, elevated creatinine kinase, and lactic acidosis, along with ischemic changes in the colon detected through colonoscopy.

It appears that exercise-induced ischemic colitis (IC) can occur in endurance athletes, especially runners. It can present with symptoms such as abdominal pain, bloody stools, and sometimes vomiting shortly after intense physical activity.

During intense exercise, there is a significant increase in metabolic demands, which triggers a physiological response that diverts blood flow away from the intestines to the muscles and heart. This reduction in blood supply to the intestines can lead to ischemia, particularly in vulnerable areas of the colon, such as the splenic flexure and sigmoid colon. Symptoms of exercise-induced IC include severe abdominal pain, bloody stools, and other gastrointestinal issues, which may resolve on their own without long-term consequences in milder cases.

Preventive measures include gradual conditioning for endurance activities, adequate hydration, and cautious use of medications like nonsteroidal anti-inflammatory drugs. Management typically involves supportive care with fluids and rest, although guidelines on recovery duration are not well-defined. Awareness of IC among athletes is crucial for early recognition and appropriate management to optimize health and performance.

 

Here is the case report: Zaffar, Duha MD1; Rivera, Eliesther MD2; Schwartz, Stephen DO3; Ali, Osman MD3; Greenwald, Bruce D. MD3. Soccer Game Turned Bloody: A Case of Exercise-Induced Ischemic Colitis. ACG Case Reports Journal 11(6):p e01406, June 2024. | DOI: 10.14309/crj.0000000000001406

 

https://journals.lww.com/acgcr/fulltext/2024/06000/soccer_game_turned_bloody__a_case_of.30.aspx

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