Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2012, Article ID 356895, 3 pages doi:10.1155/2012/356895 Case Report Ischemic Colitis in an Endurance Runner Chase Grames1 and Crist o´bal S. Berry-Cab a´n2 1 Department of Family Medicine, Womack Army Medical Center, Fort Bragg, NC 28310, USA 2 Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC 28310, USA Correspondence should be addressed to Cristo´ bal S. Berry-Caba´n, cris.berrycaban@us.army.mil Received 15 August 2012; Accepted 20 September 2012 Academic Editors: N. Matsuhashi and Y. Nakayama Copyright © 2012 C. Grames and C. S. Berry-Caba´n. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 20-year-old female running the Marine Corps Marathon developed diarrhea at mile 12. After ﬁnishing the race she noted that she was covered in bloody stool. A local emergency department suspected ischemic colitis. After discharge, her primary care physician instructed her to discontinue the use of all nonsteroidal anti-inﬂammatory drugs. Her symptoms resolved and she returned to running without any complications. This paper describes the pathophysiology, diagnostic approach, and management options. 1. Introduction Endurance competitions have become increasingly popular among the general population. From 1980 to 2008 there has been a 197% increase in the number of marathon ﬁnishers [1]. The increasing number of amateur athletes participating in endurance events provides physicians with a new set of challenges from managing chronic pain to dealing with race- day injuries. There have been more and more reports of ischemic colitis presenting in young endurance athletes. This case report examines ischemic colitis in a young female who developed bloody diarrhea during the 2010 Marine Corps Marathon. Endurance athletes suﬀer a myriad of gastrointestinal symptoms during competition and training to include bloat- ing, abdominal cramps, diarrhea, fecal incontinence, heart burn, nausea, vomiting, chest pain, urge to defecate, and bloody stools [2–4]. Gastrointestinal symptoms are reported in 20–50% of endurance athletes, more commonly in females, and more often in runners [5]. Symptoms appear to be more debilitating with longer distances or with greater intensity [6]. 2. Case Presentation A 20-year-old white female student running a marathon in Washington presented to the ﬁrst aid station at the ﬁnish line with dark red bloody diarrhea. Within the ﬁrst 10 miles she developed an urge and she had multiple small bowel movements between miles 12 and 14. She ﬁnished without further incident, but noted bloody stools. Prior to the marathon she had no gastrointestinal complaints. She had a photorefractive keratectomy 3 weeks prior to the race for which she was prescribed ibuprofen (800 mg 3X/D) which she continued during her training period. She denied any recent tobacco, alcohol, or illicit drug use and her family history was noncontributory. Her physical exam was normal; vital signs were stable with the exception of an increased heart rate and evidence of bloody stools on her clothing. Transported to a local hospital she was intravenously rehydrated and discharged without any further work out. The following day she consulted her primary care physician for continuing bloody diarrhea. He advised to discontinue ibuprofen and instructed a colonoscopy if symptoms persisted. Her diarrhea resolved spontaneously without further evaluation. 3. Discussion 3.1. Pathophysiology. Ischemic colitis is most commonly seen in the elderly with cardiovascular disease. In younger patients it is seen as a complication resulting from medications, hypercoagulable conditions such as systemic lupus erythe- matosus, or vasculitis such as polyarteritis nodosa [7]. Every segment of the colon can be aﬀected by ischemic colitis. The most frequent location is the descending colon