Ischemic colitis in an infant with constipation treated with stimulant laxative

Ischemic colitis (IC), the most common form of intestinal ischemia, ranges from superficial mucosal and submucosal injury to full-thickness mural necrosis. As risk factors include cerebrovascular disease, hypertension, diabetes mellitus, prior abdominal surgery, irritable bowel syndrome, and constipation, IC typically occurs in elderly persons with multiple comorbidities rather than young children. A 1-year-old Japanese girl receiving a stimulant laxative for constipation since age 7 months was hospitalized for fever, vomiting, and hypovolemic shock. Her abdomen was swollen, and abdominal computed tomography showed colonic distension with abundant stool. Colonic decompression and intensive care brought about rapid improvement until persistent bloody diarrhea that commenced on day 17 of illness required transfer to another hospital, where colonoscopy on day 42 showed mucosal sloughing forming pseudomembranes, as well as focal stenosis. Contrast enema on day 45 confirmed stenosis with a "thumbprint" contour at the splenic flexure. Diagnosed with IC, she received parenteral nutrition and an elemental diet. Bloody diarrhea resolved by day 75. Colonoscopy and contrast enema on day 110 showed normal mucosa and resolution of stenosis. We believe that IC arose from constipation and stimulant laxative treatment and consider this to be the first report of infantile IC complicating constipation.