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

Azimuddin K, Raphaeli T - Int J Surg Case Rep (2013)

Bottom Line: Acute ischemia of the rectum resulting in full thickness necrosis is extremely uncommon because of its excellent blood supply.If the entire rectum is found to be gangrenous then an emergency APR should be performed and the perineal wound left open.Prompt diagnosis and resuscitation followed by immediate surgical intervention is necessary to save these elderly patients.

View Article: PubMed Central - PubMed

Affiliation: Houston Colon & Rectal Surgery, 1125 Cypress Station Dr., Suite G3, Houston, TX 77090, United States. Electronic address: kazimuddin@hotmail.com.

No MeSH data available.


Related in: MedlinePlus

Ischemic necrosis of the mucosa ghost like remnants of glands with loss of the epithelium and bland necrosis of the lamina propria.
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fig0010: Ischemic necrosis of the mucosa ghost like remnants of glands with loss of the epithelium and bland necrosis of the lamina propria.

Mentions: White blood count was elevated at 24,000. Lactic acid was elevated. CT scan showed some fluid in the pelvis and mild peri rectal stranding. Patient was taken for an exploratory laparotomy in view of abdominal tenderness, septic shock, leukocytosis and lactic acidosis. After induction of general anesthesia, manual disimpaction of rectum was performed. Very foul smelling pus, stools and blood was encountered. Proctoscopy at this stage revealed a completely black rectum all the way down to the dentate line. During laparotomy a swollen, discolored and inflamed rectum was identified. An abdominoperineal resection of the rectum was performed. The perineal wound was packed with Kerlex gauze. Patient was brought to the operating room on the 5th postoperative day for delayed closure of the perineal wound. After a prolonged and slow recovery he was discharged to a nursing home on the 18th postoperative day. Histopathological exam of the specimen showed severe acute ischemic proctitis (Fig. 2).


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

Azimuddin K, Raphaeli T - Int J Surg Case Rep (2013)

Ischemic necrosis of the mucosa ghost like remnants of glands with loss of the epithelium and bland necrosis of the lamina propria.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860038&req=5

fig0010: Ischemic necrosis of the mucosa ghost like remnants of glands with loss of the epithelium and bland necrosis of the lamina propria.
Mentions: White blood count was elevated at 24,000. Lactic acid was elevated. CT scan showed some fluid in the pelvis and mild peri rectal stranding. Patient was taken for an exploratory laparotomy in view of abdominal tenderness, septic shock, leukocytosis and lactic acidosis. After induction of general anesthesia, manual disimpaction of rectum was performed. Very foul smelling pus, stools and blood was encountered. Proctoscopy at this stage revealed a completely black rectum all the way down to the dentate line. During laparotomy a swollen, discolored and inflamed rectum was identified. An abdominoperineal resection of the rectum was performed. The perineal wound was packed with Kerlex gauze. Patient was brought to the operating room on the 5th postoperative day for delayed closure of the perineal wound. After a prolonged and slow recovery he was discharged to a nursing home on the 18th postoperative day. Histopathological exam of the specimen showed severe acute ischemic proctitis (Fig. 2).

Bottom Line: Acute ischemia of the rectum resulting in full thickness necrosis is extremely uncommon because of its excellent blood supply.If the entire rectum is found to be gangrenous then an emergency APR should be performed and the perineal wound left open.Prompt diagnosis and resuscitation followed by immediate surgical intervention is necessary to save these elderly patients.

View Article: PubMed Central - PubMed

Affiliation: Houston Colon & Rectal Surgery, 1125 Cypress Station Dr., Suite G3, Houston, TX 77090, United States. Electronic address: kazimuddin@hotmail.com.

No MeSH data available.


Related in: MedlinePlus