Ischemic colitis caused by polycythemia vera: A case report and literature review

Abstract

Polycythemia vera (PV) is a chronic myeloproliferative disorder originating from hematopoietic stem cells and complicated by thrombosis and bleeding. This report describes a case of ischemic colitis (IC) caused by PV and includes a review of the relevant literature. The patient was a 59-year-old male with a history of PV who presented with abdominal pain and hematochezia. Colonoscopy and histopathological examination results indicated suspected ischemic bowel disease. Following experimental anticoagulant therapy for 7 days, the patient no longer experienced abdominal pain and hematochezia had resolved. Colonoscopy review showed no obvious anomalies 1 month later. These data demonstrated that PV is an uncommon cause of IC.

Keywords: abdominal pain; hematochezia; ischemic colitis; polycythemia vera; thrombus.

Figure 1.

Pathological changes. (A) Bone marrow cytology showed an increased red ratio. Bone marrow extracted from the anterior superior iliac spine was smeared, aired, and stained using the Wright-Giemsa method (magnification, ×1,000). (B) Bone marrow biopsy was indicative of myeloproliferative disease with pathological changes. Bone marrow was paraffin embedded following fixing with 10% formalin, dehydrated, and sectioned (2–4-µm) for hematoxylin and eosin staining (magnification, ×400).

Figure 2.

Abdominal CT scan prior to treatment. (A) Plain CT scan revealed a thickened transverse colon wall; (B) enhanced CT scan revealed irregular enhancement in the transverse colon wall (white arrows). CT, computed tomography.

Figure 3.

Manifestations of colonoscopy examination prior to treatment. Segmental and superficial ulcers, mucosal hyperemia were observed in the cecum, with hepatic flexure at the transverse colon. (A) Cecum. (B) Ulcers involved on one side of the hepatic flexure. (C) Ulcers involved all around the transverse colon.

Figure 4.

Superior and inferior mesenteric artery computed tomography angiograph in the process of treatment. Arteriosclerosis was present in the superior and inferior mesenteric artery. The white arrows point to the superior and inferior mesenteric artery, respectively.

Figure 5.

Colonoscopy review 1 month following discharge. The entire colon mucous membrane had returned to normal. (A) Cecum. (B) Hepatic flexure. (C) Transverse colon.