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Unusual cause of colonic mucosal ulceration and gastrointestinal bleeding
  1. Youseung Kim1,
  2. Varun Kesar2,
  3. David LeBel3,4
  1. 1 Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  2. 2 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  3. 3 Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  4. 4 Dominion Pathology Associates, Roanoke, Virginia, USA
  1. Correspondence to Dr Youseung Kim, Department of Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia 24014, USA; ykim1{at}

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Clinical presentation

A 60-year-old woman with a history of type 2 diabetes mellitus complicated by end-stage renal disease (ESRD) and on haemodialysis (HD) for 12 months, presented with 1 day of diffuse cramping abdominal pain associated with haematochezia. The patient denied other symptoms including fever, chills, nausea, vomiting or diarrhoea. On examination, the patient was hypotensive (75/45 mm Hg). The patient also notes that she had a similar presentation just 8 months prior and was diagnosed with ischaemic colitis presumed secondary to hypotension associated with HD. CT angiography of the abdomen and pelvis revealed segmental wall thickening of the distal transverse colon/hepatic flexure with …

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  • Contributors YK reviewed the chart, composed the first draft of the manuscript and revised the manuscript. VK reviewed the chart, obtained the radiographic and endoscopic images, and critically revised the manuscript. DL reviewed the chart, confirmed the histological diagnosis, critically revised the manuscript and supervised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.