Return to competition following ischemic colitis caused by severe dehydration.

OBJECTIVE This article summarizes a case of ischemic colitis suffered by a triathlete during an Ironman competition. BACKGROUND Exercise results in a significant reduction in splanchnic blood flow to help maintain cardiovascular function. When dehydration and heat stress accompany exercise, blood flow to the splanchnic vasculature is further reduced, increasing the risk of local ischemia and tissue injury. DIFFERENTIAL DIAGNOSIS Ischemic colitis caused by dehydration and heat stress. TREATMENT Right hemicolectomy involving a 16-cm segment of ischemic large intestine and appendectomy the day following the race. UNIQUENESS This case study highlights one of the risks associated with dehydration during prolonged exercise in the heat. Of particular interest are practical interventions to reduce health and performance issues. CONCLUSIONS Poor hydration and nutrition practices during intense exercise can affect gut function, impair performance, and jeopardize health. Optimal intake of fluid, carbohydrate, and salt will enhance performance and reduce risk to health.