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Ischemic proctitis 6 months after laparoscopic sigmoidectomy: a case report.

Takuto Yoshida1, Nobuki Ichikawa2, Shigenori Homma1

  • 1Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, W-7, Kita-ku, Sapporo, N-15060-8638, Japan.

Surgical Case Reports
|February 22, 2021
PubMed
Summary

A rare case of ischemic proctitis occurred 6 months after sigmoidectomy. Non-surgical management, including hyperbaric oxygen therapy, successfully healed rectal ulcers, highlighting the importance of considering blood flow during surgery.

Keywords:
Bloody stoolHyperbaric oxygen therapyIschemic colitisIschemic proctitisLaparoscopic sigmoidectomyNon-surgical managementSigmoid colon cancer

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Surgical Pathology

Background:

  • Ischemic colitis is common, but its pathophysiology, particularly ischemic proctitis post-sigmoidectomy, is not fully understood.
  • This report details a rare instance of ischemic proctitis developing six months after a laparoscopic sigmoidectomy.

Purpose of the Study:

  • To present a rare case of ischemic proctitis following laparoscopic sigmoidectomy.
  • To discuss the management and outcomes of this condition.
  • To emphasize considerations for preventing ischemic proctitis in surgical patients.

Main Methods:

  • A 60-year-old male patient with hypertension, diabetes, hyperlipidemia, and a smoking history underwent laparoscopic sigmoidectomy for sigmoid colon cancer.
  • Post-surgery, the patient developed symptoms of lower abdominal discomfort, bloody stools, and tenesmus.
  • Colonoscopy revealed extensive rectal ulcers; treatment included hyperbaric oxygen therapy.

Main Results:

  • The patient presented with severe rectal ulcers distal to the anastomotic site six months post-laparoscopic sigmoidectomy.
  • Non-surgical management, notably hyperbaric oxygen therapy, led to the healing of rectal ulcers within 48 days.
  • The patient experienced no recurrence of symptoms for over 3.5 years.

Conclusions:

  • Careful consideration of anal-side blood backflow is crucial during sigmoidectomy procedures.
  • Patients with risk factors for ischemic proctitis require particular attention to prevent post-operative complications.
  • This case underscores the importance of vigilant post-operative monitoring and tailored management strategies.