Hyperamylasaemia and ischaemic colitis

Ischaemic colitis is a differential diagnosis to be considered in patients who have a high cardiovascular risk. Presentation of severe ischaemia is usually that of an acute abdomen with passage of fresh blood per rectum, and hyperamylasaemia.

A 66-year-old gentleman was admitted to A&E with a short history of central abdominal pain, nausea, vomiting and fresh bleeding per rectum. A diagnosis of ischaemic colitis was made by the computed tomography (CT) scan findings of colonic thickening and pneumatosis, in addition to colonoscopy demonstrating sloughy mucosa and ulceration. Symptoms did not resolve with conservative management, therefore laparotomy+Hartmann's procedure was performed. Histology showed extensive areas of both partial and full thickness ischaemia with stricture.

Amylase is an indicator of intra-abdominal inflammatory processes. Hyperamylasaemia (normal <100U/l) is most frequently associated with pancreatitis; however, causation is not exclusive and other differentials including bowel ischaemia must be considered, although amylase is not a specific marker for ischaemic colitis. It is important to distinguish between ischaemic and ulcerative colitis.

Intestinal ischaemia is a serious acute abdominal pathology that is associated with hyperamylasaemia, and frequently requires prompt surgical intervention to prevent subsequent mortality.