本文報告一位85 歲女性病人，她有高血壓、糖尿病、心血管疾病、鬱血性心衰竭及失智 症。她因血尿及下消化道出血住院，其腹部及骨盆腔電腦斷層發現橫結腸腫瘤，故接受大腸 鏡以對腫瘤切片，病理報告證實它是腺癌。作完大腸鏡隔日，她發燒、腹脹，檢驗白血球數 目竄高，經檢查排除急性冠心症、心律不整及泌尿道感染。再隔日病人發生低血壓，當日安 排腹部電腦斷層檢查以評估腹內感染，結果發現於遠端橫結腸、脾彎及乙狀結腸有腸壁囊樣 積氣(pneumatosis intestinalis)，符合缺血性腸炎表現。經積極治療包括輸液、強心劑、抗生 素、呼吸器等，多重器官衰竭仍快速惡化，於此狀況追蹤大腸鏡及手術亦有所顧忌。最後病 人因多重器官衰竭逝世。文獻回顧：缺血性腸炎是大腸鏡檢查後的罕見併發症，其誘病因素 包括結締組織疾病、高齡及心血管疾病，但也有不具這些誘病因素的病例報告。對於具誘病 因素者，作大腸鏡應給予充足輸液、謹慎清腸、避免鏡檢中過度充氣、縮短鏡檢時間。大腸 鏡檢查後須注意併發症並作適當處置。

This case is an 85 year-old female with hypertension, diabetes mellitus, cardiovascular disease, congestive heart failure and dementia. She was admitted for hematuria and low gastrointestinal bleeding, the computed tomography scan of the abdomen and pelvis revealed a transverse colon tumor. She received a colonoscopy that found the tumor made transverse colon almost completely obstruction. The pathology of tumor biopsy showed adenocarcinoma. Unfortunately, abdominal fullness, fever, severe leukocytosis developed one day after the colonoscopy and then hypotension was detected. There was no evidence of arrhythmia or acute coronary syndrome. A follow-up abdominal computed tomography revealed pneumatosis intestinalis at the distal transverse colon, splenic flexure and sigmoid colon, compatible with ischemic colitis. Despite intensive treatment including hydration, inotropic agent infusion, antibiotics therapy and ventilatory support, she died of soon multi-organ failure. Literatures were reviewed for discussion. Ischemic colitis is a rare complication of colonoscopy. The predisposing factors for developing ischemic colitis following colonoscopy include connective tissue disease, advanced age and cardiovascular disease. Ischemic colitis may rarely occur following a colonoscopy without these predisposing factors. For patients with risk factors, we should supply adequate fluids for them, do careful bowel preparation, avoid hyperinflation during the procedure and shorten the procedure time. Be aware of the possible complications including ischemic colitis after colonoscopy and do the proper management. (J Intern Med Taiwan 2015; 26: 213-216)