Ischemic colitis associated with acute carbon monoxide poisoning--a case report

Area of Science:

• Toxicology
• Gastroenterology
• Cardiology

Background:

• Carbon monoxide (CO) poisoning is a common environmental hazard.
• Ischemic colitis is a rare but serious complication of CO poisoning.
• This case examines a patient with severe CO poisoning and subsequent gastrointestinal and cardiac complications.

Observation:

• A 34-year-old female presented with unconsciousness and incontinence after car exhaust exposure, with a 23% carboxyhemoglobin level and metabolic acidosis.
• She developed severe abdominal pain, rectal bleeding, nausea, vomiting, and hypoactive bowel sounds.
• Physical examination revealed lower abdominal tenderness; vital signs showed tachycardia and tachypnea. ECG indicated sinus tachycardia with T-wave inversions; troponin I was elevated, and echocardiogram showed reduced ejection fraction.

Findings:

• Abdominal CT scan demonstrated diffuse colonic mural thickening, indicative of mesenteric ischemia.
• Sigmoidoscopy revealed edematous, friable, pale mucosa in the rectum and distal sigmoid colon.
• The patient's hematochezia resolved over three days; cardiac MRI was normal. Hyperbaric oxygen therapy was deferred.

Implications:

• This case underscores the potential for severe gastrointestinal complications, including ischemic colitis, following carbon monoxide poisoning.
• It highlights the importance of considering mesenteric ischemia in patients with CO poisoning and abdominal symptoms.
• Prompt recognition and management of CO poisoning can lead to favorable long-term outcomes, even with initial cardiac and gastrointestinal involvement.