Acute colorectal ischaemia after anaphylactoid shock

Area of Science:

• Gastroenterology
• Vascular Medicine
• Toxicology

Background:

• Ischemic proctitis is a condition characterized by inflammation and damage to the rectum and colon due to reduced blood flow.
• While often associated with vascular disease or specific risk factors, spontaneous cases can occur.
• Oral contraceptives have been anecdotally linked to vascular events, necessitating further investigation into their role in gastrointestinal ischemia.

Observation:

• A 29-year-old woman presented with bloody diarrhea shortly after experiencing anaphylactoid shock.
• Diagnostic procedures including sigmoidoscopy, barium enema, and histology revealed ischemia of the rectum and colon up to the splenic flexure.
• The patient had no prior history of vascular disease but was using oral contraceptives.

Findings:

• The patient experienced complete recovery from the ischemic event.
• The case highlights a potential association between anaphylactoid shock, oral contraceptive use, and spontaneous ischemic proctitis.
• A review of 31 additional cases of spontaneous ischemic proctitis is included for comparison and further analysis.

Implications:

• This case suggests that oral contraceptives might be a contributing factor in the development of spontaneous ischemic proctitis, particularly in the context of systemic events like anaphylactoid shock.
• Further research is warranted to elucidate the mechanisms linking oral contraceptives and gastrointestinal ischemia.
• Clinicians should consider ischemic proctitis in the differential diagnosis of bloody diarrhea, especially in patients with risk factors such as oral contraceptive use or recent systemic shock.