Article

Acute gangrenous proctitis

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Abstract

Vascular disease leading to ischemic injury of the colon has been recognized for many years. Colorectal ischemia has been reported as an infrequent complication of abdominal aortic aneurysmectomy and bypass surgery for aortoiliac occlusive disease.1–5

Isolated ischemic injury involving the rectosigmoid and rectum is unusual, but has been reported in up to 6% of cases in some series.6 Typically, ischemic injury of the rectum clinically follows a protracted course, but acute transmural infarction and perforation may be presenting symptoms. We report two cases of isolated acute gangrenous proctitis that occurred in the past year at the Cleveland Clinic Hospital.

Case reports

Case 1. A 79-year-old hypertensive, diabetic woman was admitted to the Cleveland Clinic Hospital in November 1979 for evaluation of left phantom limb pain for 2 years after amputation of the left lower limb for gangrene. The patient had a history of myocardial infarction and aortoiliac occlusive disease for which she had undergone aortobifemoral reconstruction in 1977.

On November 11 she underwent placement of a left sciatic nerve stimulator. She did well until the second postoperative day when she had a temperature of 102 F and a decrease in mentation. She complained of crampy lower abdominal pain that was most severe in the left lower quadrant and not associated with nausea, vomiting, diarrhea, or rectal bleeding. On physical examination her abdomen was soft, nondistended but tender to palpation in both lower quadrants (most severe on the left). Bowel sounds were absent. The pelvic examination was nonrevealing and the . . .


 

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