• Bowel preparation
• Colon ischemia
• Colonoscopy
• Endoscopy
• Ischemic colitis
• Mesenteric circulation

• Colitis, Ischemic/diagnostic imaging
• Colitis, Ischemic/etiology
• Colon/diagnostic imaging
• Colonoscopy
• Humans
• Ischemia/etiology
• Mesenteric Ischemia

Colonoscopy is widely used for the diagnosis and management of colorectal disease and requires adequate bowel preparation. Ischemic colitis is a form of intestinal ischemia that presents with abdominal pain, diarrhea, and hematochezia. Risk factors include advanced age, cardiovascular disease, and diabetes. Both colonoscopy and bisacodyl bowel preparation have been described as rare causes of ischemic colitis with less than 35 cases collectively in the literature. Our review found that of these cases, there exists significant heterogeneity within individual patient characteristics. The majority of the cases are managed conservatively without complications or sequela. Due to the risk of ischemic colitis, the FDA has withdrawn bisacodyl bowel preparations from use in the USA. Bisacodyl bowel preparations are still used in Canada.

Here, we present two cases of ischemic colitis in previously healthy women aged 57 and 69 who underwent screening colonoscopy using bisacodyl bowel preparation. Both were treated conservatively without complications.

Thus far, there has been one documented case of ischemic colitis following colonoscopy with bisacodyl bowel preparation; here, we present two additional cases with one case occurring without the presence of known risk factors for ischemic colitis. Our literature review finds that there is limited evidence surrounding bisacodyl as a causative agent of ischemic colitis. Cases often contain confounding variables such as the presence of known risk factors for ischemic colitis. Our report aims to highlight the need for a more comprehensive analysis evaluating the safety of bowel preparations as well as increasing the clinical awareness surrounding the rare risk of colonoscopy-induced ischemic colitis.

• Colon ischemia
• Colonoscopy
• Ischemic colitis
• Risk factors
• Surgery

• Colitis, Ischemic/diagnosis
• Colitis, Ischemic/epidemiology
• Colitis, Ischemic/therapy
• Disease Management
• Humans
• Risk Factors

• Adult
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Colitis, Ischemic/diagnosis
• Colitis, Ischemic/drug therapy
• Colitis, Ischemic/etiology
• Colonoscopy/adverse effects
• Diagnosis, Differential
• Female
• Humans
• Treatment Outcome

The clinical presentation and outcome of ischemic colitis have a wide spectrum. Impaired perfusion of blood to the bowel from a variety of causes is the underlying pathophysiology. The presence of diarrhea, abdominal pain, and mild lower gastrointestinal bleeding should prompt consideration of ischemic colitis as a cause. Although many laboratory tests and radiographic images may suggest the diagnosis, endoscopic visualization of the colonic mucosa with histologic analysis of biopsies is the gold standard for identification of colonic ischemia. Many cases are transient and resolve without any complications. Medical therapy for chronic ischemia has been anecdotally proven but not carefully studied. Complications of ischemic colitis can include bowel perforation, peritonitis, persistent bleeding, protein-losing colonpathy, and symptomatic intestinal strictures. Surgical resection of the affected segment should be considered early to minimize adverse outcomes. This review describes the etiology, pathophysiology, clinical features, diagnostic approach, and management of ischemic colitis.

• Ischemic colitis
• Diagnosis
• Therapy
• Etiology
• Pathophysiology

• Tollefson classification
• bloody diarrhea
• ischemic colitis
• pancolitis