缺血性大腸炎可以有相當不同嚴重性的臨床表現。大多數病人呈現出輕到中度臨床病 程，而且通常可以完全復原。少數嚴重案例可以有長期合併症，譬如腸道狹窄或演變成慢性 缺血性大腸炎。慢性缺血性大腸炎可以表現出腸道潰瘍，有時呈現非連續性腸炎間接穿插一 些正常的腸道黏膜，因而可能看似克隆式症的內視鏡表徵。在這個病例報告中，是一位59 歲 女性，過去病史具有多重臨床合併症，主述腹痛腹瀉及血便，經大腸鏡檢發現嚴重大腸發炎 及潰瘍，並且有合併狹窄。後來經過右側大腸部分切除術，術後病理學報告證實缺血性大腸 炎。所以，對於年長病患同時具有多重臨床合併症，如果臨床主述腹痛及血便，臨床醫師如 果具備高度警覺及即時鑑別診斷的準備，將有助於早期正確診斷缺血性大腸炎。

Ischemic colitis can present a wide spectrum of severity; most patients are mild to moderate in clinical course and can be treated supportively and expected to recover fully, while a minority with severe ischemia may develop long term complication such as stricture or chronic ischemic colitis. Chronic ischemic colitis may lead to chronic ulcerations in segments of colon and separated by normal-appearing mucosa, mimicking Crohn’s disease. Here we present a case of 59-year-old female who has multiple comorbid presented with progressive abdominal pain associated with diarrhea and rectal bleeding. Colonoscopy showed severely inflamed severe stricture at the hepatic flexure. Right hemicolectomy was performed and surgical pathology confirmed chronic ischemic colitis. Raising awareness of this disease entity and having a high index of suspicion, especially in the setting of elder patients presenting with abdominal pain, rectal bleeding, and existence of comorbid status is crucial to establish an early diagnosis. (J Intern Med Taiwan 2017; 28: 298-303)