Ischemic Colitis during Pregnancy and Contraceptive Medication

Abstract

Ischemic bowel disease is generally considered a disease of the elderly and usually consists of reversible colopathy. Nonocclusive causes of ischemic colitis include low-flow states due to cardiac dysfunction and hypovolemia and use of certain medications including progestational medication. We report 2 cases of ischemic colitis in young women. The first one occurred in a young patient who developed three consecutive episodes of ischemic colitis during her pregnancy, whereas the second woman presented with ischemic colitis in relation with the estrogen use. Each episode had a favorable outcome. Having ruled out an infectious cause, or a low blood flow state and in the absence of known thrombogenic disease, we hypothesized the etiology of these ischemic episodes to a high level of circulating estrogens due to pregnancy in the first case and oral contraceptive medication in the second. Physicians treating hemorrhagic colitis in young women should consider the use of contraceptive medication containing estrogens or pregnancy as possible causes.

Ischemic colitis associated with hormonal contraceptive treatment delivered via vaginal ring

“…Some studies have suggested that a genetic predisposition to thrombosis may play an important role in the pathogenesis of ischemic colitis in young women (5). It has also been described during pregnancy, probably related to the high circulating levels of estrogens (6). In almost half of the cases, the cause is not found (2).…”

A case of ischemic colitis during pregnancy

“…[1][2][3] However, cases of ischemic colitis associated with pregnancy are very rare. 4,5 We report a case of ischemic colitis occurring in the eighth week of pregnancy.…”

The Ever-Changing Landscape of Drug-Induced Injury of the Lower Gastrointestinal Tract

“…The presence of ischemic colitis in young patients should always raise the possibility of drug involvement, especially oral contraceptives, 18 cocaine, 19,20 and migraine medication, like ergotamine derivatives 21 and potentially sumatriptan. 22 Oral contraceptives produce a hypercoagulable state and may cause mesenteric vein fibrosis.…”