Lubiprostone induced ischemic colitis

Abstract

Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding. It is often multifactorial and more commonly encountered in the elderly. Several medications have been implicated in the development of colonic ischemia. We report a case of a 54-year old woman who presented with a two-hour history of nausea, vomiting, abdominal pain, and bloody stool. The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding. The radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her condition improved without any serious complications after the cessation of lubiprostone. This is the first reported case of ischemic colitis with a clear relationship with lubiprostone (Naranjo score of 10). Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.

Keywords: Colonoscopy; Gastrointestinal bleeding; Ischemic colitis; Lubiprostone; Rectal bleeding.

Figure 1

The laboratory studies results. A: Computed tomography scan shows thickening of the colonic wall involving the splenic flexure of the colon; B: Normal mucosa in the right colon (appendiceal orifice); C: Ischemic colitis features in the splenic flexure of the colon; D: Normal mucosa in sigmoid with a small polyp; E, F: Histopathology shows ischemic loss of crypts and acute hemorrhage in lamnia propria (acute hemorrhagic necrosis replacing glands) associated with acute fibrinopurulent exudate at colonic epithelial surface, consistent with ischemic colitis.

Figure 2

Mechanism of action of lubiprostone across epithelial intestinal cells[8].