Case: 34 years old athletic male is admitted to ICU with severe abdominal pain with a presumed diagnosis of intestinal ischemia. In a young athletic male, which side is more prone to ischemic colitis? (select one)
A) left
B) right
Answer: B
Athletes with underlying risk factors such as iron deficiency anemia, dehydration, or cardiovascular disease may develop Exercise-induced intestinal ischemia. It mostly involves proximal colon due to an increased susceptibility of end arteries in low-flow states. Said that it can occur in other parts of the intestine as well. During exercise, mesenteric blood flow may decrease up to 50 to 80 percent.
Pathogenesis doesn't only involve a low flow state or hypovolemia but increased intestinal permeability due to mucosal injury. This is correlated with exercise intensity, duration, dehydration, and higher environmental temperature. In severe cases, rectal bleeding and/or blood in diarrhea may occur. Abdominal pain is usually severe, vague, and persistent even after cessation of exercise.
IV hydration is usually sufficient but, in extreme cases, may require surgical intervention.
#surgical-critical-care
References:
1. Wright H, Collins M, Villiers RD, Schwellnus MP. Are splanchnic hemodynamics related to the development of gastrointestinal symptoms in Ironman triathletes? A prospective cohort study. Clin J Sport Med 2011; 21:337.
2. Beaumont AC, Teare JP. Subtotal colectomy following marathon running in a female patient. J R Soc Med 1991; 84:439.
3. Moses FM. Exercise-associated intestinal ischemia. Curr Sports Med Rep 2005; 4:91.
4. Sanchez LD, Tracy JA, Berkoff D, Pedrosa I. Ischemic colitis in marathon runners: a case-based review. J Emerg Med 2006; 30:321.
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