Introduction: Melanosis coli is a condition in which the colon develops a brown to black discoloration. It is associated with chronic laxative use and frequently diagnosed incidentally during colonoscopy or histopathologic evaluation.
Case presentation: A 74-year-old woman presented to the Emergency Department with severe abdominal pain and bilious emesis. During a cecal volvulus repair, her melanosis coli was nearly misdiagnosed as bowel ischemia.
Discussion: Melanosis coli is a diagnostic finding that can easily be confused with bowel ischemia, which may create a dilemma for the surgeon who is attempting to make a decision regarding the extent of a colonic resection. As such, a pathology consult is warranted in any patient with suspected ischemic colitis and concerns for concomitant melanosis coli.