Evanescent colitis

Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.