# Vaso-Occlusive Thrombotic Ischemic Colitis Presenting With Large-Volume Hematochezia in Sickle Cell Beta+-Thalassemia

## TL;DR

A patient with sickle cell beta-thalassemia experienced severe gastrointestinal bleeding due to vaso-occlusive ischemic colitis, highlighting the need for prompt diagnosis.

## Contribution

This case report highlights vaso-occlusive thrombotic ischemic colitis as a rare but important cause of hematochezia in sickle cell beta+-thalassemia.

## Key findings

- The patient's hematochezia was caused by ischemic colitis with thrombosed submucosal vessels.
- Colonoscopy and histopathology confirmed vaso-occlusive microthrombosis in the rectosigmoid colon.
- The case emphasizes the importance of early endoscopic evaluation in sickle cell patients with gastrointestinal bleeding.

## Abstract

We present the case of a 60-year-old African American man with sickle cell beta plus thalassemia who developed large-volume hematochezia during hospitalization for a vaso-occlusive crisis. Sickle cell disease is characterized by chronic hemolysis and vaso-occlusion that can affect the gastrointestinal tract, although clinically significant colonic ischemia remains rare. The patient had a history of diverticulosis and hemorrhoids but presented with acute lower gastrointestinal bleeding after dehydration and nonsteroidal anti-inflammatory drug exposure, both of which can impair mucosal perfusion. Colonoscopy revealed discontinuous ulcerations in the rectosigmoid colon, and histopathology confirmed ischemic colitis with thrombosed submucosal vessels, consistent with vaso-occlusive microthrombosis. This case underscores the importance of early endoscopic evaluation and recognition of ischemic colitis as a potential cause of overt gastrointestinal bleeding in patients with sickle cell disease.