Abstract
BackgroundIschemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy.Case presentationThe patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years.ConclusionsWhile performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.
Highlights
Ischemic colitis is a common disease; its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy
We present a case of ischemic proctitis that occurred 6 months after laparoscopic sigmoidectomy and treated by non-surgical management
He continues to take Prostaglandin E1 (PGE1) and has Discussion Ischemic colitis is defined as a localized and reversible ischemic colonic lesion [1, 2] that usually occurs at the ileocecal junction and around the Griffith’s point and Sudeck’s point [3]
Summary
Ischemic proctitis after sigmoidectomy might be related to underlying arteriosclerosis and anatomical blood flow insufficiency. Abbreviations CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CT: Computed tomography; HBO: Hyperbaric oxygen therapy; NO: Nitric oxide; PGE1: Prostaglandin E1
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