Bowel Ischemia from Heat Stroke: A Rare Presentation of an Uncommon Complication

Abstract

A healthy 27-year-old female presented to the hospital after she collapsed an hour into her first marathon run on a hot humid day. On presentation, she was hyperthermic, encephalopathic, tachycardic, and hypotensive. On admission, she was found to have lactic acidosis, rhabdomyolysis, and acute kidney injury and was treated with cold normal saline and cooling blankets. She subsequently started having abdominal pain and bloody bowel movements. Computed tomography of the abdomen revealed ascending colon thickening. Furthermore, her lab findings showed transaminitis and elevated coagulation parameters. Due to the acute hypotensive state from the heat stroke, patient had developed bowel ischemia, ischemic hepatitis, and disseminated intravascular coagulation, all of which are uncommon complications of heat stroke. She was managed aggressively with intravenous fluid hydration with resolution of her symptoms over the course of 4 days. In addition to the uncommon complications, early presentation of this bowel ischemia despite adequate hydration in such a healthy individual is another unique aspect of the case.

Expert consensus on the diagnosis and treatment of heat stroke in China

“…In the acute phase of HS, high fever, reduced blood volume and gastrointestinal ischemia (diversion of gastrointestinal blood to the skin and muscle), oxidative stress and DIC may lead to gastrointestinal mucosal ischemia, intestinal wall edema, intestinal effusion and even bleeding [32,33]. Gastrointestinal dysfunction can occur within 72 h of HS onset, presenting as nausea, vomiting, abdominal pain, diarrhea, and drainage-like stool, and patients with severe HS may have gastrointestinal hemorrhage, perforation and peritonitis [34,35].…”

Emphysematous cholecystitis during the treatment of heat stroke

“…Previous studies reported the occurrence of bowel ischemia 5 and colon perforation 6 during the treatment of heat stroke. Furthermore, older patients and those undergoing hemodialysis with arteriosclerosis as an underlying disease may experience ischemic and necrotic changes after recovery from shock 7 .…”