Pudendal Artery Syndrome Presenting as Ischemic Proctitis: Report of 3 Cases

Abstract

Ischemic proctitis due to pudendal artery syndrome is described in 3 cases. The patients showed common clinical and investigative findings which included: anal pain and bleeding; strainodynia; tender, edematous and ulcerated rectal neck, as well as obliterated distal internal pudendal artery. Manifestations of pudendal neuropathy were also present. The inflammatory process was localized to the rectal neck. Bilateral internal pudendal artery obliteration with non visualization of the inferior rectal arteries is suggested to define proctitis as ischemic. Pudendal artery obstruction seems to result from levator subluxation and sagging which pulls on the pudendal vessels and nerve resulting in pudendal canal syndrome. Pudendal canal decompression achieved elimination of the symptoms and healing of the rectal neck lesions in the 3 cases. To our knowledge, the first 3 cases of ischemic proctitis caused by pudendal artery syndrome are reported here.

On the Pathogenesis of Acute Ischemic Proctitis

“…We previously reported on AIP caused by pudendal artery syndrome. 2 The patients showed common clinical and investigative findings, which included anal pain and bleeding, and tender, edematous, and ulcerated anal canal. Selective pudendal arteriography revealed obliteration of the distal part of the internal pudendal artery (IPA), which corresponded to the part in the pudendal canal.…”