A 73-year-old male, without drug allergies, with a history of dyslipidemia on statin therapy, stable ischemic heart disease on treatment with acetylsalicylic acid, transdermal nitrates and beta-blockers prior to bilateral analgesic tramadol herpurin treatment.
He also had end-stage chronic renal failure, so he underwent dialysis sessions three days a week and received treatment with polystyrene carbonate without sorbitol.
The patient was admitted to our hospital because of rectal bleeding during a hemodialysis session.
At the time of admission, the patient had a hemoglobin level of 6.5 g/dl, despite receiving 4 vials of medication prior to arrival at our center.
Physical examination revealed hemodynamic lability with a tendency to hypotension. An urgent abdominal CT angiography showed no active bleeding.
After hemodynamic stabilization, a fibrogastroscopy was performed, which showed a large hiatal hernia without other lesions. The lesions were consistent with ischemic colitis at the cecum level, right colon and hepatic angle.
The anatomopathological study was compatible with ischemic colitis, with deposit of kalimate crystals in the granulation tissue of the bottom of one of the ulcers.
The patient was discharged after 8 days.
