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INTRODUCTION
Boley et al documented the first cases of reversible colonic injury resulting from ischaemia of the colon in 1963.1 At least 50 further cases have subsequently been reported in the literature with as yet no common aetiological factors elicited.2–10 This report documents two extensively investigated cases with no obvious precipitant except for a preceding aeroplane flight.
CASE REPORT NO 1
A 43 year old woman took a 10 hour flight to the USA. A few hours after arrival she developed vomiting, diarrhoea, and abdominal pain. She collapsed and was admitted to hospital where she had a further episode of diarrhoea with some fresh rectal bleeding. A diagnosis of gastroenteritis was made and she was discharged. Twenty four hours later she was admitted to another hospital with further rectal bleeding, abdominal pain, and a vasovagal episode. There were no abnormal physical findings. She underwent urgent colonoscopy which showed oedema, friability, and cobblestoning from the distal transverse colon to the descending colon (fig 1). Biopsies were taken from this area (fig 2) and showed a surface acute inflammatory cell exudate, mucosal haemorrhage, and gland dropout consistent with the effects of ischaemic damage. The rest of the large bowel was normal and ischaemic colitis was diagnosed. Her symptoms settled and she returned to the UK where she was referred as an outpatient. There was no past history of coagulopathy or cardiac abnormalities and she did not smoke. She had not been taking any medication (including herbal remedies and oral contraceptives). Examination revealed no evidence of peripheral emboli or vasculitis. Heart sounds were normal and blood pressure was 115/70. Abdominal examination revealed mild right iliac fossa tenderness …