S3890 Bisacodyl-Induced Ischemic Colitis Following Colonoscopy Preparation in a 58-Year-Old Female: A Case Report

Introduction: Ischemic colitis is the most common form of intestinal ischemia. It typically affects elderly patients with cardiac comorbidities. While often multifactorial, stimulant laxative-induced ischemic colitis is a rare but increasingly recognized entity. This case report describes a 58 yr Black woman who developed ischemic colitis following a routine surveillance colonoscopy using bisacodyl bowel prep. Case Description/Methods: A 58-year-old Black woman with a history of asthma, hypercholesterolemia, and prior colon polyps presented for a routine colonoscopy. She underwent bowel prep with a regimen including bisacodyl. Prior to the colonoscopy, she began experiencing rectal bleeding, which she attributed to the bowel prep medication. Following the colonoscopy, she developed left lower quadrant abdominal pain. She denied dizziness, leg cramps, palpitations, or chest pain. complete blood count was unremarkable. A follow-up colonoscopy performed on April 16, 2024, revealed endoscopic features consistent with ischemic colitis, including erythema and mucosal friability in the sigmoid colon. She was managed supportively with bowel rest, hydration, and close monitoring, leading to complete symptom resolution. Discussion: The association between bisacodyl and ischemic colitis has been documented in case studies. Shamatutu et al. (2020) described 2 patients developing IC shortly after bisacodyl-based colonoscopy preparation. Similarly, Ajani et al. (2012) reported IC in a young woman using bisacodyl and oral contraceptives. The temporal relationship between bisacodyl use and symptom onset, along with exclusion of other common causes, supports a causal link. Our patient had several low-risk features: she was relatively young, lacked cardiovascular disease, and was not hypotensive or dehydrated. However, bisacodyl’s stimulation of colonic motility, compounded by possible dehydration from bowel prep, likely led to transient colonic hypoperfusion. This case illustrates a rare but important adverse effect of bisacodyl, a commonly used agent for colonoscopy preparation. Clinicians should remain vigilant for signs of ischemic colitis in the immediate post-procedural period, especially in patients who develop rectal bleeding or abdominal pain. Consideration should be given to using gentler bowel regimens in at-risk populations, and patient education about potential symptoms should be part of routine counseling. Further studies are warranted to clarify the incidence and risk factors for stimulant laxative-induced ischemic colitis.