Acute Ischemic Proctitis: Report of Four Cases

Abstract

Acute ischemic proctitis is an extremely rare clinical entity. It is mainly described in patients with significant atherosclerotic and cardiac risk factors who present with lower gastrointestinal symptoms in the setting of hemodynamic instability. Previous reports of ischemic proctitis suggest that rectal resection is not necessary in the treatment of this disease. We present four cases of acute ischemic proctitis that required complete proctectomy. All patients had large vessel atherosclerosis with rectal bleeding and sepsis as the presenting signs and symptoms. Three of four patients underwent complete proctectomy as the initial procedure. The fourth patient underwent complete proctectomy five days after the initial intervention. Two of four patients survived and were ultimately discharged from the hospital. A third patient recovered from surgery but ultimately died of respiratory complications. Only the patient who was initially treated by subtotal proctectomy died as the result of the disease. Although ischemic necrosis of the rectum is rare, complete proctectomy may be necessary to save the patient's life.

Acute ischemic gangrene of the rectum: Report of 3 cases and review of literature

“…We do not recommend leaving behind a gangrenous or ischemic segment of the rectum as has been suggested by some 9 . Rather we support the view of Maun et al that leaving behind a gangrenous rectal segment will be a source of persistent sepsis and should be removed 10 . A drain should be left in pelvis and stools be diverted with a colostomy.…”

A Case of Unresectable Rectal Necrosis

“…A report by Maun et al [13] disagrees with what Nelson et al have proposed and favors the performance of complete proctectomy in cases of rectal necrosis as retention of dead rectum may add a persistent source of sepsis. The authors describe four cases with acute ischemic proctitis.…”

Anorectal bleeding: etiology, evaluation, and management (with videos)

“…In severe cases, a pelvic CT scan may be obtained to rule out pneumatosis and extraluminal air-findings that suggest transmural necrosis and may dictate surgical intervention. 106 Most cases respond to conservative, nonoperative management that includes antibiotics, but severe Anorectal bleeding Daram et al cases requiring complete proctectomy with colostomy have been reported. 103,106 If localized bleeding is noted, endoscopic hemostasis can be attempted with injection therapy, thermal coagulation, or clip application.…”

“…106 Most cases respond to conservative, nonoperative management that includes antibiotics, but severe Anorectal bleeding Daram et al cases requiring complete proctectomy with colostomy have been reported. 103,106 If localized bleeding is noted, endoscopic hemostasis can be attempted with injection therapy, thermal coagulation, or clip application. In patients with refractory bleeding, angiography with embolization can be successful, but concerns for aggravating the ischemia exist.…”