Non-Occlusive Exercise-Induced Ischemic Colitis After Marathon Running: A Case Report

Abstract:Introduction:Exercise-induced ischemic colitis is an uncommon but clinically relevant condition in emergency medicine, particularly among endurance athletes presenting with abdominal pain and gastrointestinal bleeding after prolonged physical exertion.Case Report:A 56-year-old female endurance athlete receiving oral hormone replacement therapy presented to the emergency department with moderate-to-severe cramp-like abdominal pain and frank hematochezia a few hours after completing a 42 km marathon. On admission, she was hemodynamically stable, with localized tenderness in the left lower abdominal quadrant and no signs of peritonitis. Laboratory evaluation showed no significant hyperlactatemia, and the gastrointestinal molecular panel was negative. Abdominal and pelvic computed tomography angiography demonstrated diffuse, symmetric, stratified mural thickening of the transverse and descending colon with marked submucosal edema, while the major mesenteric vessels remained patent. Conservative treatment was initiated with intravenous fluids, bowel rest, and analgesia. Colonoscopy revealed multiple ulcers in the descending colon and proximal sigmoid colon, consistent with an ischemic etiology.Conclusion:Exercise-induced ischemic colitis should be considered in endurance athletes presenting with abdominal cramps and hematochezia after prolonged exertion. Normal serum lactate levels do not exclude ischemic colonic injury, particularly when limited to the mucosal or submucosal layers. Computed tomography angiography is useful to exclude major occlusive vascular disease and to support conservative management in the absence of peritonitis or transmural necrosis.References:References are included in the main manuscript in Vancouver style.