A 26-year-old male with no history of interest or toxic habits.
She presented with sudden diffuse abdominal pain, uncontrollable bilious vomiting and profuse sweating.
Five hours after the onset of symptoms, she presented abundant rectal bleeding with clots, independent emission of stools and without pain relief.
There were no other associated symptoms.
The patient was outstanding abroad in military mission and reported having performed from three days before and during the central hours of the day at high room temperature, training sessions of 20 minutes of bodybuilding and 2 hours of continuous running.
The day of clinical onset, in addition, training began immediately after copious food intake.
The patient was transferred to a local hospital with poor general condition and low-grade fever, where the objective was "leucocytosis and creatinine elevation" and an endiculum elevation was performed, which reflects a large amount of intense intramammary edema.
The patient was kept under observation for 24 hours with absolute diet, serum therapy and intravenous ciprofloxacin.
The persistence of the clinical signs and symptoms and the appearance of drowsiness and cérea, the Spanish military doctors in charge of the patient requested air evacuation to our center.
On arrival, 48 hours after the onset of symptoms, the patient was hypertensive, tachycardic, with good baseline oxygen saturation and low-grade fever.
Physical examination revealed a soft, slightly distended, tender abdomen due to diffuse superficial and deep irritation signs, with voluntary contraction of the peritoneal muscles, without clear signs of irritation.
The rectal examination showed fresh frozen remains.
Complete blood tests were performed on 26,010 leukocytes (neutrophils) and glucose 146 mg/dl as the only findings.
A CT scan of the pelvis was performed (without and with intravenous contrast) in which a marked dilatation of the colon was found, with diffuse thickening of the wall, involvement of peri-abdominal free fat, large number of lymph nodes smaller than 1 cm.
We completed the study regions with emergency pseudoseizures in which only 100 cm was introduced with biopsy due to high risk of perforation. Deep geographic ulcerations were observed from the rectosigmoid junction and proximal mucosa.
The endoscopic diagnosis was ischemic colitis, which was later confirmed with the anatomopathological results.
The patient was treated conservatively with absolute diet, nutrition, intravenous therapy, analgesia and corticotherapy.
Control was performed at 12 days of admission in which the previously described alterations persisted.
No vascular alterations were observed in CT angiography.
Immunological and hypercoagulability studies were normal.
No outbreaks were observed.
Coprocultives were repeatedly negative.
Inflammatory bowel disease was ruled out by histology not compatible with this pathology.
The patient was discharged asymptomatic 29 days after admission.
A new approach was performed 6 weeks after discharge, which revealed an ad valorization of the mucosa.
After ruling out another etiology, it was established that the origin of the condition was a vascular sequestration produced by the increased blood demands for intense exercise in a hot day, in a patient with most of his cardiac output.
