Internal Medicine Canyon vista medical center sierra vista, Arizona, United States
Clinical Scenario or Case: A 22-year-old previously healthy male presented with sudden-onset abdominal pain and hematochezia. He denied NSAID use, recent antibiotics, or illicit drugs but reported chronic nicotine vaping and social alcohol use. Imaging revealed ischemic colitis and distal ileitis. Exploratory laparotomy showed inflammation of the transverse, descending, and sigmoid colon, and dilated small bowel loops. His course was complicated by shock requiring vasopressors and acute renal failure requiring dialysis. Colonoscopy confirmed active colitis with ulceration and ileitis. Extensive infectious, autoimmune, and hypercoagulable workups were negative. Fecal calprotectin was markedly elevated (3710 μg/g), and biopsies confirmed acute ischemic colitis. He improved with supportive care and was discharged for outpatient follow-up.
Evidence/Literature Review: Ischemic colitis is typically seen in older adults with cardiovascular disease, diabetes, or coagulopathies. Common etiologies include hypotension, thrombosis, and medications. IC is rare in young, healthy individuals without traditional risk factors. Animal studies have demonstrated that vaping may induce oxidative stress, impair mucosal integrity, and promote colonic inflammation, potentially increasing susceptibility to ischemia.
Unique Aspects of Case: This case represents a rare presentation of ischemic colitis in a healthy young adult with no identifiable risk factors aside from chronic vaping. Despite an exhaustive negative workup, he developed severe systemic complications, highlighting the possible role of transient hypoperfusion and microvascular injury.
Recommendations/Conclusions: In young patients with unexplained ischemic colitis, a broad differential should be maintained. Vaping may represent an emerging, underrecognized risk factor for mucosal vulnerability. Supportive care remains the mainstay of treatment, but awareness of nontraditional exposures is critical. Further research is warranted into the gastrointestinal effects of vaping and its role in ischemic injury.
