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Acute ischemic proctitis: report of four cases
Dipen Maun1, Daniel Silverberg, Randolph M Steinhagen
1Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, New York 10029, USA.
Diseases of the Colon and Rectum
|December 13, 2006
Summary
Acute ischemic proctitis, a rare condition in patients with atherosclerosis, may necessitate complete proctectomy. This surgical intervention, while drastic, can be life-saving in severe cases of rectal ischemia.
Area of Science:
- Gastroenterology
- Vascular Surgery
Background:
- Acute ischemic proctitis is rare, typically affecting patients with cardiovascular risk factors and hemodynamic instability.
- Previous literature suggested conservative management for ischemic proctitis, often avoiding rectal resection.
Observation:
- This study details four cases of acute ischemic proctitis.
- All patients presented with severe symptoms including rectal bleeding and sepsis, linked to large vessel atherosclerosis.
Findings:
- Contrary to prior reports, all four patients required complete proctectomy for treatment.
- Three patients underwent immediate proctectomy, with the fourth requiring it five days later.
- Survival rates were 50% post-proctectomy, with mortality linked to initial management choices.
Implications:
- Complete proctectomy, though rarely indicated, may be essential for managing severe acute ischemic proctitis.
- Findings challenge previous assumptions about the non-surgical necessity of rectal resection in ischemic proctitis.
- Highlights the critical role of aggressive surgical intervention in life-threatening cases of rectal ischemia.
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