Venous Congestive Ischemic Colitis After Sigmoid Colectomy: A Case Report

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Vascular Surgery

Background:

• Ischemic colitis is a potential complication following colorectal surgery.
• Preservation of the inferior mesenteric artery (IMA) is common in sigmoid colon cancer resection.
• Venous congestion can lead to ischemic colitis, particularly when arterial supply is maintained.

Observation:

• A 73-year-old male presented with symptoms of refractory ischemic enterocolitis two weeks post-sigmoid colon cancer resection with IMA preservation.
• Imaging revealed edematous wall thickening near the anastomosis.
• Colonoscopy showed rectal mucosal swelling, erythema, and erosion distal to the anastomosis.

Findings:

• Histopathological examination confirmed ischemic colitis due to venous congestion.
• The patient's symptoms persisted despite conservative management, necessitating surgical intervention.
• Findings suggest an arterial-venous blood flow imbalance post-IMA preservation.

Implications:

• Venous congestion should be considered in the differential diagnosis of ischemic colitis after colorectal surgery with mesenteric artery preservation.
• Recognizing this etiology may help prevent complications such as anastomotic leakage.
• This case underscores the importance of evaluating venous outflow in addition to arterial inflow in colorectal reconstructions.