Ischemic Colitis or Colon Cancer: A Diagnostic Dilemma

Ischemic colitis, a potentially reversible pathology of the colon, can masquerade in its presentation as colonic carcinoma. It typically presents with cramping abdominal pain, diarrhea, and per-rectal bleeding. Colonoscopy remains the diagnostic modality of choice that typically shows friable, edematous, or erythematous mucosa with scattered hemorrhagic erosions or ulcerations. Although rare, the colonoscopic findings can sometimes reveal a tumor mass that confounds the diagnosis of ischemic colitis as colonic carcinoma. Our patient was a 78-year-old female with no previous colon cancer screening who presented with a mass-forming variant of ischemic colitis. Due to the overlap in presentations, radiographic findings, and colonoscopic findings, the diagnostic challenge was evident. Ultimately, colon cancer was ruled out through thorough colonoscopic follow-up and biopsy-guided pathological analysis. This case signifies the importance of considering colonic mass as a guise of underlying ischemic colitis to ensure an accurate diagnosis and the best possible outcome for the patient.