A case of unresectable rectal necrosis

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Rectal necrosis is an uncommon condition with limited established management protocols.
• Abundant collateral vasculature typically protects the rectum from ischemic events.
• Existing literature lacks a clear consensus on the optimal treatment strategy.

Observation:

• A 53-year-old female patient with multiple comorbidities presented with septic shock and hematochezia.
• Colonoscopy confirmed ischemic colitis, and initial conservative management was initiated.
• Two weeks later, the patient developed peritonitis, necessitating an exploratory laparotomy.

Findings:

• Exploratory laparotomy revealed extensive necrosis of the left colon and rectum.
• Resection was deemed unsafe due to severe inflammation and technical challenges.
• A transverse ostomy with a mucosal fistula and abdominal drains was performed.

Implications:

• This case demonstrates a viable alternative surgical approach for rectal necrosis when resection is not feasible.
• Diverting ostomy with mucosal fistula and drainage can lead to successful outcomes in critical patients.
• This approach may be considered when extensive distal colon and rectal dissection is unsafe due to patient condition or surgical complexity.