A 28-year-old woman with no relevant personal history who had received contraceptive hormonal treatment (etonogestrel and ethinylestradiol) with an intravaginal ring over the past two years due to menstrual disorders.
During this time she developed chronic constipation, so she was treated with a cold, edematous mucosa in the descending colon with superficial ulcerations covered by fibrin.
Histopathological study of biopsies showed atrophic and regenerative changes in the epithelium with presence of microthrombi.
The neutrophilic infiltrate was minimal, but with significant submucosal edema.
The changes were attributable to ischemia, although the causes of ischemia were still to be determined.
After fixation, the vaginal ring was removed and recurrence of the defect was observed 4 months later.
Constipation was corrected with conventional measures.
In order to exclude other possible causes of ischemic colitis, an analytical study, electrocardiogram, echocardiogram and abdominal CT angiography were normal.
The hypercoagulability study showed an antigenic and anticoagulant protein S deficiency.
Neither Leyden factor V nor the FII G20210A mutation of the prothrombin gene were detected.
The family study showed the same alteration in the patient's father.
