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Ischemic proctitis: case series and literature review
1Department of Surgery, University of Illinois at Chicago/Metropolitan Group Hospitals-St. Francis Hospital, Evanston, Illinois 60202, USA.
The American Surgeon
|January 16, 2007
Summary
Rectal ischemia is uncommon but serious. Early diagnosis via colonoscopy is crucial for appropriate management, with nonoperative treatment for mild cases and surgery for severe, transmural necrosis.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Colorectal Surgery
Background:
- Ischemic injury to the rectum is rare due to its robust vascular supply.
- Risk factors include vascular occlusive disease, compromised collateral circulation, and low flow states.
- Early diagnosis and management are critical for patient outcomes.
Purpose of the Study:
- To analyze the clinical presentation, risk factors, and outcomes of acute rectal ischemia.
- To evaluate the diagnostic utility of colonoscopy in cases of suspected rectal ischemia.
- To determine the impact of disease severity on mortality rates.
Main Methods:
- A retrospective review of acute rectal ischemia cases over a 20-year period.
- Analysis of patient data including risk factors, diagnostic methods, and treatment approaches.
- Correlation of endoscopic findings with clinical outcomes and mortality.
Main Results:
- Aortoiliac occlusive disease and low flow states were the primary risk factors identified.
- Colonoscopy was the key diagnostic tool for assessing ischemic changes.
- Transmural necrosis had a significantly higher mortality rate (40%) compared to patchy ischemic changes (20%).
Conclusions:
- Acute rectal ischemia, though rare, carries significant morbidity and mortality.
- Prompt diagnosis using colonoscopy and appropriate management based on severity are essential.
- Vascular disease and low flow states are major contributors to rectal ischemia.
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