The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 11

**Note** The authors would like to acknowl-
edge Perkins Mukunyadzi, MD for his contribution
of pathology images.
References
1. Duffy MJ. Carcinoembryonic antigen as a
marker for colorectal cancer: is it clinically use-
ful? Clinical Chemistry. 47:4 624-63, 2001.
2. McLoughlin JM, Jensen EH, Malafa M. Resec-
tion of colorectal liver metastases: current per-
spective. Cancer Control 13: 322-41, 2006.
3. Improved survival after resection of liver and
lung colorectal metastases: a study of 112
patients with limited lung metastatic disease.
Broquet A, Vauthey JN, Contreras CM et al. J
Am Coll.Surg 213: 62-69, 2011.
Figure 3. Serial CEA measurements in ng/mL
after surgery in the two patients with gangrenous
colitis. Time to normalization was six months in
the patient with chronic segmental colitis. Our
patient with chronic segmental colitis normal-
ized his CEA levels 18 months from surgery. 6-8
The CEA level recorded in our patient was much
higher compared with the Japanese patient. Inci-
dence of ischemic colitis is often underestimated
on account of mild and transient symptoms. Our
patient did not report any symptoms before his
colonoscopy; bleeding was more prominent after
the procedure.
Ischemic colitis is rare after colorectal sur-
gery and more common after aortic surgery. Fac-
tors predisposing to ischemic colitis in this popu-
lation include use of vasopressors and increased
transfusion (> 7 units PRBC). Pelvic radiation has
been reported to predispose to ischemic colitis af-
ter aortic surgery. Preoperative inferior mesenteric
artery patency has also shown to be an important
factor predisposing to IC after aortic surgery. 9, 10
Factors thought to predispose to ischemic colitis
in our patient includes age (>65) (90% of IC oc-
curs in this age group), hypertension, increased
transfusion requirement, and prior pelvic radia-
tion. Inferior mesenteric artery was noted to be
patent on CT angiogram in our patient.
Treatment of ischemic colitis depends on
severity of presentation. Most cases of ischemic
colitis are transient and reversible and do not re-
quire specific therapy. Acute presentation requires
supportive care including intravenous fluids, anti-
biotics, and bowel rest. Parenteral nutrition may
be necessary for patients requiring bowel rest.
Patients with bowel infarction and perforation re-
quire emergent surgery. Most patients with acute
ischemic colitis show resolution of symptoms in
24 to 48 hours and complete resolution in two
weeks. Some of the patients with severe ischemic
colitis may develop persistent colitis or ischemic
stricture. Topical steroids may have a role in ther-
apy of chronic colitis. Symptomatic patients with
segmental colitis and ischemic colitis can under-
go curative segmental resection. Asymptomatic
patients with strictures should be observed since
some of these patients show resolution in 12-to-
24 months. 5
CEA is a useful tumor marker in colorectal
malignancy; however, it is elevated in a variety
of benign diseases such as alcoholic hepatitis,
cirrhosis, pancreatitis, biliary obstruction, colitis,
colonic polyposis, and smokers. Elevations are
usually mild and rarely greater than 10. Greater
levels have been reported occasionally. 11 Isch-
emic colitis is a very rare cause of elevated CEA;
our patient was predisposed on account of mul-
tiple factors stated above. CEA was significantly
elevated prompting imaging studies to rule out
recurrent disease in our patient. This case further
illustrates the fact that elevated tumor mark-
ers alone should not be the basis for initiation or
changing the therapy in colorectal malignancy
unless supported by imaging, colonoscopy, and
pathologic studies.
4. Tomlinson JS, Jarnigan WR, DeMatteo RP et
al: Actual 10 year survival after resection of
colorectal liver metastasis defines cure. J Clin
Oncol 25:4575-4580, 2007.
5. Theodoropoulou A, Koutroubakis IE. Ischemic
colitis: clinical practice in diagnosis and treat-
ment. World Journal of Gastroenterology 14:
7302-7308, 2008.
6. Iwaisako K, Kamo N, Seo S et al. Two cases of
ischemic colitis accompanied with elevated se-
rum CEA. The Japanese Journal of Gastroen-
terological Surgery 73: 1716- 1721, 2008.
7. Kaomi H, Ishimine T, Kamayema S, Matsumura
T, Isa T, Kunushima N. A case of gangrenous
ischemic colitis with abnormally elevated
CEA. Journal of Japan Surgical Association 73:
1716-1721, 2012.
8. Nasu T, Kobayashi Y, Fukiage O et al. A case of
stricture – type ischemic colitis showing false
negative for CEA mimicking rectal cancer.
Journal of Japan Surgical Association. 2014;
75: 1944-48.
9. Miller A, Marrota M, Scordi-Bello I, Tammaro
Y.Divino C. Ischemic colitis after endovascular
aortoiliac aneurysm repair. A 10 year retro-
spective study. Archives of Surgery 144: 900-
903,2009
10. Israeli D, Dardik H, Wolodiger F, Scheri B,
Chessler R. Pelvic radiation therapy as a risk
factor for ischemic colitis complicating ab-
dominal aortic reconstruction. J Vasc Surgery
23: 706-709, 1996.
11. Lowenstein MS, Zamchek N. Carcinoembry-
onic antigen (CEA) levels in benign gastro-
intestinal disease states. Cancer 42: 1412-
1418, 1978.
NUMBER 7
JANUARY 2019 • 155