Surgical abdomen masked by metabolic crisis: fulminant ischemic colitis in severe diabetic ketoacidosis - a case report and literature review

By
Jun Seong Chung
Jae Seung Kim
Jae Kyun Ju
July 13, 2026

Frontiers In Endocrinology

Overview

This case study presents a 30-year-old woman with type 1 diabetes who developed severe ischemic colitis during a hyperglycemic crisis. She required emergency surgery due to evolving intestinal ischemia despite biochemical improvement.

Background

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are significant causes of emergency admissions, often presenting with abdominal pain. While abdominal symptoms typically resolve with metabolic correction, persistent or worsening symptoms may indicate serious complications such as intestinal ischemia, which can lead to rapid deterioration and necessitate surgical intervention.

Data Highlights

No numerical data or trial data available in the article.

Key Findings

A 30-year-old woman with type 1 diabetes presented with severe hyperglycemia and metabolic acidosis.
She developed hemodynamic instability and progressive abdominal symptoms despite initial biochemical improvement.
Non-contrast CT revealed pneumatosis intestinalis, indicating intestinal ischemia.
Emergency subtotal colectomy was performed, confirming transmural infarction of the ascending colon.
Post-operative management included intensive care and renal replacement therapy, leading to her recovery.

Clinical Implications

Healthcare professionals should be vigilant for signs of intestinal ischemia in patients with DKA, even when biochemical parameters appear to improve.

Conclusion

This case highlights the importance of recognizing that biochemical improvements do not rule out serious intra-abdominal complications in hyperglycemic crises.