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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

Purplish black and ischemic rectal mucosa. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
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fig0015: Purplish black and ischemic rectal mucosa. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Mentions: An 80-year old female was admitted from nursing home with history of bloody diarrhea. Past medical history included hypertension, hyperlipidemia and history of stroke. She was hypotensive and septic. White cell count was 17,000. CT scan showed thickening of the rectal wall. She was started on IV fluids, vasopressors and intravenous antibiotics. A bedside flexible sigmoidoscopy was performed which revealed severe ischemia and necrosis of the rectal mucosa (Fig. 3). Mild ischemic changes extended up to the splenic flexure. After resuscitation an exploratory laparotomy was performed which revealed frank gangrene of almost the entire rectum except the last 2 cm above the dentate line. Low anterior dissection of the rectum was performed all the way down to the levators and anal canal. Here the anorectal stump was stapled off and divided. A near complete proctectomy and Hartman's procedure was performed. Because the anal canal was viable, we were able to avoid an abdominoperineal resection of the rectum. The abdomen was washed with copious amounts of normal saline and large drains were left in the pelvis. Postoperative recovery was slow but uneventful and the patient was finally transferred back to the nursing home. Histopathology showed extensive necrosis of the mucosa extending into the muscularis propria.


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

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

Purplish black and ischemic rectal mucosa. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig0015: Purplish black and ischemic rectal mucosa. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Mentions: An 80-year old female was admitted from nursing home with history of bloody diarrhea. Past medical history included hypertension, hyperlipidemia and history of stroke. She was hypotensive and septic. White cell count was 17,000. CT scan showed thickening of the rectal wall. She was started on IV fluids, vasopressors and intravenous antibiotics. A bedside flexible sigmoidoscopy was performed which revealed severe ischemia and necrosis of the rectal mucosa (Fig. 3). Mild ischemic changes extended up to the splenic flexure. After resuscitation an exploratory laparotomy was performed which revealed frank gangrene of almost the entire rectum except the last 2 cm above the dentate line. Low anterior dissection of the rectum was performed all the way down to the levators and anal canal. Here the anorectal stump was stapled off and divided. A near complete proctectomy and Hartman's procedure was performed. Because the anal canal was viable, we were able to avoid an abdominoperineal resection of the rectum. The abdomen was washed with copious amounts of normal saline and large drains were left in the pelvis. Postoperative recovery was slow but uneventful and the patient was finally transferred back to the nursing home. Histopathology showed extensive necrosis of the mucosa extending into the muscularis propria.

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