Non-Occlusive Exercise-Induced Ischemic Colitis After Marathon Running: A Case Report

Abstract

Abstract: Introduction: Exercise-induced ischemic colitis is an uncommon but clinically relevant condition in emergency medicine, particularly among endurance athletes presenting with abdominal pain and gastrointestinal bleeding after prolonged physical exertion. Case Report: A 56-year-old female endurance athlete receiving oral hormone replacement therapy presented to the emergency department with moderate-to-severe cramp-like abdominal pain and frank hematochezia a few hours after completing a 42 km marathon. On admission, she was hemodynamically stable, with localized tenderness in the left lower abdominal quadrant and no signs of peritonitis. Laboratory evaluation showed no significant hyperlactatemia, and the gastrointestinal molecular panel was negative. Abdominal and pelvic computed tomography angiography demonstrated diffuse, symmetric, stratified mural thickening of the transverse and descending colon with marked submucosal edema, while the major mesenteric vessels remained patent. Conservative treatment was initiated with intravenous fluids, bowel rest, and analgesia. Colonoscopy revealed multiple ulcers in the descending colon and proximal sigmoid colon, consistent with an ischemic etiology. Conclusion: Exercise-induced ischemic colitis should be considered in endurance athletes presenting with abdominal cramps and hematochezia after prolonged exertion. Normal serum lactate levels do not exclude ischemic colonic injury, particularly when limited to the mucosal or submucosal layers. Computed tomography angiography is useful to exclude major occlusive vascular disease and to support conservative management in the absence of peritonitis or transmural necrosis. References: References are included in the main manuscript in Vancouver style.

Keywords

• ischemic colitis
• exercise
• marathon running
• hematochezia
• computed tomography
• case report

Supporting Institution

No external funding, grants, or institutional financial support were received for the preparation of this manuscript.

Project Number

Not applicable

Ethical Statement

Written informed consent was obtained from the patient for the publication of this case report and the accompanying clinical images. The manuscript contains no identifiable personal information. Because this is a single case report and no experimental intervention was performed, formal ethics committee approval was not required.

Thanks

The authors have no acknowledgments to declare.

Maraton Sonrası Hormon Replasman Tedavisi Kullanan Bir Hastada Non-Oklüzif Egzersize Bağlı İskemik Kolit: Olgu Sunumu

Abstract

Abstract: Introduction: Egzersize bağlı iskemik kolit, özellikle dayanıklılık sporcularında uzun süreli fiziksel efor sonrası karın ağrısı ve gastrointestinal kanama ile acil servise başvurduklarında göz önünde bulundurulması gereken nadir ancak klinik açıdan önemli bir durumdur. Case Report: Oral hormon replasman tedavisi kullanan 56 yaşında kadın dayanıklılık sporcusu, 42 km’lik maratonu tamamladıktan birkaç saat sonra başlayan orta-şiddetli kramp tarzında karın ağrısı ve belirgin hematokezya nedeniyle acil servise başvurdu. İlk değerlendirmede hasta hemodinamik olarak stabildi; sol alt kadranda hassasiyet mevcuttu, ancak periton irritasyon bulgusu yoktu. Laboratuvar değerlendirmesinde belirgin hiperlaktatemi saptanmadı ve gastrointestinal moleküler panel negatifti. Abdominal ve pelvik bilgisayarlı tomografi anjiyografide transvers ve inen kolonda yaygın, simetrik ve tabakalı duvar kalınlaşması ile submukozal ödem izlendi; majör mezenterik damarlarda oklüzyon saptanmadı. Hasta intravenöz sıvı tedavisi, barsak istirahati ve analjezi ile konservatif olarak tedavi edildi. Kolonoskopide inen kolon ve proksimal sigmoid kolonda iskemik etiyoloji ile uyumlu ülserler saptandı. Conclusion: Uzun süreli fiziksel efor, karın krampları ve hematokezya birlikteliği, acil serviste egzersize bağlı iskemik kolit açısından klinik şüphe uyandırmalıdır. Normal serum laktat düzeyleri, özellikle iskemi mukozal veya submukozal tabakalarla sınırlı olduğunda kolonik iskemiyi dışlamaz. Bilgisayarlı tomografi anjiyografi, majör oklüzif vasküler olayları dışlamak ve uygun konservatif yönetimi desteklemek için önemli bir tanısal araçtır. References: The references are included in the main manuscript file in Vancouver style.

Keywords

• İskemik kolit
• Egzersiz
• Maraton koşusu
• Hematokezya
• Bilgisayarlı tomografi anjiyografi
• Olgu sunumu

Supporting Institution

Bu makalenin hazırlanması için herhangi bir dış finansman, hibe veya kurumsal mali destek alınmamıştır.

Project Number

Not applicable

Ethical Statement

Bu olgu sunumunun ve eşlik eden klinik görüntülerin yayımlanması için hastadan yazılı bilgilendirilmiş onam alınmıştır. Makalede hastayı tanımlayabilecek kişisel bilgi bulunmamaktadır. Bu çalışma tek bir olgu sunumu olduğundan ve deneysel bir müdahale içermediğinden, etik kurul onayı gerekli görülmemiştir.

Thanks

Yazarların beyan edeceği bir teşekkür bulunmamaktadır.

References

1. 1. de Oliveira EP, Burini RC, Jeukendrup A. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations. Sports Med 2014; 44 Suppl 1: S79-85. doi: 10.1007/s40279-014-0153-2.
2. 2. Ribichini E, Scalese G, Cesarini A, Mocci C, Pallotta N, Severi C, et al. Exercise-induced gastrointestinal symptoms in endurance sports: a review of pathophysiology, symptoms, and nutritional management. Dietetics 2023; 2: 289-307. doi: 10.3390/dietetics2030021.
3. 3. Papantoniou K, Michailides C, Bali M, Papantoniou P, Thomopoulos K. Gastrointestinal bleeding in athletes. Ann Gastroenterol 2023; 36: 267-74. doi: 10.20524/aog.2023.0788.
4. 4. Hung A, Calderbank T, Samaan MA, Plumb AA, Webster G. Ischaemic colitis: practical challenges and evidence-based recommendations for management. Frontline Gastroenterol 2021; 12: 44-52. doi: 10.1136/flgastro-2019-101204.
5. 5. Zaffar D, Rivera E, Schwartz S, Ali O, Greenwald BD. Soccer game turned bloody: a case of exercise-induced ischemic colitis. ACG Case Rep J 2024; 11: e01406. doi: 10.14309/crj.0000000000001406.
6. 6. Masterman BJ, Ambulkar T, Hartrick O. Exercise-induced ischemic colitis from home-based high-intensity interval training (HIIT). Cureus 2024; 16: e55791. doi: 10.7759/cureus.55791.
7. 7. Kelly MR, Emerson DM, McDermott BP, Atkins WC, Butts CL, Laursen RM, et al. Gastrointestinal cell injury and perceived symptoms after running the Boston Marathon. Front Physiol 2023; 14: 1268306. doi: 10.3389/fphys.2023.1268306.
8. 8. Costa RJS, Young P, Gill SK, Snipe RMJ, Gaskell SK, Russo I, et al. Assessment of exercise-associated gastrointestinal perturbations in research and practical settings: methodological concerns and recommendations for best practice. Int J Sport Nutr Exerc Metab 2022; 32: 387-418. doi: 10.1123/ijsnem.2022-0048.

9. 9. Gaskell SK, Burgell R, Wiklendt L, Dinning PG, Costa RJS. Impact of exercise duration on gastrointestinal function and symptoms. J Appl Physiol (1985) 2023; 134: 160-71. doi: 10.1152/japplphysiol.00393.2022.
10. 10. van Wijck K, Lenaerts K, Grootjans J, Wijnands KAP, Poeze M, van Loon LJC, et al. Physiology and pathophysiology of splanchnic hypoperfusion and intestinal injury during exercise: strategies for evaluation and prevention. Am J Physiol Gastrointest Liver Physiol 2012; 303: G155-68. doi: 10.1152/ajpgi.00066.2012.