Acute ischaemic colitis in a female long distance runner.

Abstract

SUMMARY A 34 year old female long distance runner is reported with bloody diarrhoea. Colonoscopy revealed patchy haemorrhagic mucosal lesions throughout the colon. The most extensive lesions were found in the sigmoid colon. Histologic examination disclosed mucosal haemorrhage, dilated capillaries, patchy fibrosis and superficial erosions. Additional findings in this patient were haemorrhagic gastritis, microscopic haematuria and rhabdomyolysis. The only medication taken by the patient was oral contraceptives. We conclude that ischaemic colitis is one of the possible mechanisms leading to gastrointestinal blood loss in competitive runners.Abdominal discomfort and alteration in gastrointestinal function are common in runners. Twenty five per cent of runners had abdominal cramps or diarrhoea in association with competitive running.' Although occult gastrointestinal bleeding seems to be quite common2" bloody diarrhoea remains a rare event.' The pathophysiology of gastrointestinal bleeding during physical exercise is poorly understood, but bowel ischaemia has been proposed as a possible mechanism.2"' We report on a female long distance runner with a bloody diarrhoea syndrome caused by acute ischaemic colitis.Case report A 34 year old female long distance runner was referred to our hospital because of bloody diarrhoea. She competed in a 15 km mountain race; the altitude ranged between 540 and 870 m and the temperature was 14 to 18°C. At 10 km she experienced generalised severe crampy abdominal pains, forcing her to stop the race. During the next hour she noted bloody red stools, over the next few hours she subsequently vomited and noted small portions of blood. The same day she was referred for clinical evaluation. The patient had been in good health all

Diagnosis and management of splanchnic ischemia

“…Splanchnic ischemia develops well before systemic hemodynamic instability arises [24] . This splanchnic vasoconstriction may be triggered by shock states, including hemorrhage, sepsis, dehydration or cardiac failure, from vasoactive medications, nicotine and cocaine abuse, or even in strenuous exercise [19,[25][26][27] or severe psychological stress [28] . This combination of ischemia despite normal vessel anatomy, has given rise to the term non-occlusive mesenteric ischemia (NOMI).…”

Exercised-Induced Ischemic Colitis in a Recreational Athlete Previously Attributed to Inflammatory Bowel Disease

“…Second, our patient was a well-conditioned athlete who developed severe symptoms during a low-level of activity. Case reports have described ischemic colitis in both well-trained professional athletes and relatively unconditioned amateur athletes [7,11,12,14]. These reports, however, primarily described symptom onset during or following strenuous effort when athletes operated near their peak physiologic abilities, which was not the case for our patient.…”

“…Gross GI blood loss following exercise is less common, although one study reported 16% of runners experienced bloody diarrhea on at least one occasion following strenuous exertion [6]. Development of ischemic colitis in this population is rare, however [7,10,[11][12][13][14]. Several hypotheses to explain this phenomenon have be proposed.…”

Ischaemic colitis in an ironman triathlete: A case report and review of the literature

“…2 Of the seven previously reported cases of exerciseinduced ischaemic colitis, all were associated with amateur long distance runners. 3,5 Of these, five had involvement of the proximal colon, one had pancolitis and the seventh had involvement of the sigmoid and rectum. Six of these seven cases were managed conservatively, with aggressive intravenous rehydration being the mainstay of treatment.…”