Exercise-Induced Colon Ischemia in a Middle-Aged Female Athlete: Response to a Novel Therapeutic Approach of Sildenafil and Fludrocortisone

Colon ischemia is the most frequent form of intestinal ischemia. It is likely most commonly caused by mesenteric vasoconstriction in the microvasculature, though such vasoconstriction has never been documented, considering colonic blood flow has already normalized by the time of presentation. Long-distance running is a rare cause, presumably from blood shunting away from splanchnic vasculature. No effective treatment has previously been reported. We present a 41-year-old woman with recurrent abdominal pain and hematochezia after exercise. Initial workup was unrevealing, prompting a clinical diagnosis of exercise-induced colon ischemia from transient, reversible mesenteric vasoconstriction. Treatment with the vasodilator sildenafil and fludrocortisone for blood pressure support resulted in symptom resolution and her ability to return to exercise without adverse gastrointestinal symptoms.