Ischemic pancolitis: recognizing a rare form of acute ischemic colitis.

A 62-year-old woman presented with septic shock and was referred after the results of an initial laparotomy were negative. Afterward, she was persistently hypotensive and required mechanical ventilation. Abdominal computed tomographic imaging revealed free air in her upper abdomen and diffuse thickening of the entire colon. Flexible sigmoidoscopy showed patchy areas of mucosal necrosis in the colon. At a second laparotomy, the serosa of the rectosigmoid and splenic flexure were noted to be dusky red, with multiple perforations. A total colectomy and ileostomy were performed. Histological examination revealed extensive areas of fullthickness necrosis throughout the entire length of the colon.