Necrosis of the colon as a complication of shock

Colonic necrosis secondary to hypotension and shock in previously healthy, young patients is a rare occurrence with only ten cases reported in the literature. In all but one instance the necrosis was limited to the right colon. Three additional cases of transmural necrosis involving both the right and left colon following a documented episode of shock are reported. Two cases were related to hemorrhagic shock following trauma and the third case followed a drug overdose with associated hypotension. An episode of hypotension was the common denominator in all cases previously reported. The lowest mean blood pressure in the present series was 35 mmHg. A diagnosis of subtotal colonic infarction was made at laparotomy in these three patients two to nine days after the initial hypotensive episode. Pathologic examination of the excised colon revealed transmural necrosis in all three cases with no evidence of a thrombotic or embolic process accounting for the colonic necrosis. The etiology was felt to be a low flow state within the splanchnic circulation. The data suggests that patients who present with a history of prolonged hypotension and shock are at risk for the development of colonic infarction. Successful management involves early diagnosis and resection of the infarcted colon.