S4969 A Young Gut Gone Rogue: Ischemic Colitis in a Healthy 22-Year-Old

Introduction: Ischemic colitis is the most common form of gastrointestinal ischemia, resulting from compromised colonic blood flow. Predisposing factors include trauma, thrombosis, systemic hypoperfusion, mechanical obstruction, and certain medications. We present a rare case of ischemic colitis in an otherwise healthy young adult without identifiable risk factors. Case Description/Methods: A 22-year-old man with no significant medical history presented with sudden-onset abdominal pain and hematochezia. He denied significant alcohol use, recreational drugs, NSAID use, or recent antibiotics but reported vaping nicotine for 3 years and social alcohol consumption. A computed tomography scan of the chest, abdomen, and pelvis revealed findings consistent with ischemic colitis of the distal ileum. Emergent exploratory laparotomy showed diffuse inflammation of the transverse, descending, and sigmoid colon, along with dilated and hyperemic small bowel loops, suggesting a global inflammatory process. His hospital course was complicated by shock requiring vasopressors and acute renal failure needing dialysis. Colonoscopy with biopsies confirmed active colitis with ulceration and ileitis. Infectious, autoimmune (vasculitis), and hypercoagulable workups were unremarkable, and urine toxicology was negative. Fecal calprotectin was significantly elevated at 3710 μg/g. Biopsies confirmed the diagnosis of acute ischemic colitis. The patient improved with supportive care and was discharged with plans for outpatient gastroenterology follow-up and a repeat colonoscopy. Discussion: Acute ischemic colitis typically occurs in older adults with risk factors such as cardiovascular disease, diabetes, and hypercoagulable states. In this young patient, transient hypoperfusion from hemodynamic instability and vasopressor use likely contributed. Ketamine administration may have further affected cardiovascular dynamics. Although comprehensive evaluations were negative, transient mesenteric thrombosis or microvascular injury during systemic inflammation cannot be excluded. Notably, animal studies suggest that chronic vaping induces oxidative stress and colonic inflammation, possibly compromising mucosal integrity and predisposing to ischemic injury. This case underscores the multifactorial nature of ischemic colitis in young adults and highlights vaping as a potential, emerging risk factor.