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Multimodality Diagnosis of Mesenteric Ischemia
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Rectal ischemia mimicked tumor mass.

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Ischemic proctitis, a rare condition in elderly patients, can mimic rectal cancer. Early recognition and conservative management are crucial for effective treatment and avoiding fatal outcomes.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Ischemic proctitis is a rare condition often seen in elderly patients with comorbidities.
  • Hematochezia and hypotension can be presenting symptoms.

Purpose of the Study:

  • To present a case of ischemic proctitis mimicking a rectal neoplasm.
  • To discuss the diagnostic and therapeutic challenges of this rare entity.
  • To review the relevant literature on causes, prognostic factors, and management.

Main Methods:

  • Case presentation of an 80-year-old male with severe coronary disease.
  • Endoscopic evaluation revealing a rectal mass and rectosigmoid inflammation.
  • Literature review on ischemic colitis and its mimics.

Main Results:

  • The ischemic proctitis presented with severe hematochezia and hypotension, mimicking a neoplastic lesion.
  • Severe mucosal and submucosal edema with hemorrhagic nodules can resemble malignancy.
  • A distal obstructing lesion or disorder is present in 10%-20% of ischemic colitis cases.

Conclusions:

  • Early recognition of ischemic proctitis is vital to guide appropriate therapy, distinguishing it from inflammatory or infectious bowel diseases.
  • Conservative management with close follow-up and repeat endoscopy with biopsies is the recommended initial approach.
  • Misdiagnosis can lead to potentially fatal treatments.