Isolated ascending colon ulceration in a patient with chronic renal insufficiency

Chronic renal hemodialysis or transplantation may be accompanied by a myriad of gastrointestinal problems. Ischemic bowel disease, spontaneous perforation diverticulitis, appendicitis, fistulae, and angiodysplasia have all been reported in the literature. Isolated colonic ulcerations have been described as a cause of both massive hemorrhage and spontaneous perforation. The exact predisposing factors are unknown. Ischemia, immunosuppression, and cytomegalovirus may play important roles in pathogenesis. This article describes a case of both hemorrhage and spontaneous colonic perforation accompanying end-stage renal disease in a patient who was not undergoing long-term dialysis or posttransplantation immunosuppression.