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Journal of General Internal Medicine

, Volume 23, Issue 9, pp 1525–1527 | Cite as

An Unusual Case of Hematochezia: Acute Ischemic Proctosigmoiditis

  • Kumar Abhishek
  • Shivu Kaushik
  • Mehdi M. Kazemi
  • Samer El-DikaEmail author
Case Reports/Clinical Vignettes

Abstract

Acute ischemia of the rectum is uncommon and usually occurs after aorto-iliac surgery. In this report, we present a case of acute ischemic proctosigmoiditis that developed from a brief episode of hypotension. An 85-year-old male presented to the emergency room with hypotension, mental confusion, and passage of maroon-colored stool. He was resuscitated and treated for presumed sepsis. Computerized tomography of the abdomen and pelvis displayed signs of acute inflammation of the distal colon and rectum. Endoscopic findings and microscopic examination of the rectal biopsy revealed changes consistent with acute ischemic proctosigmoiditis. An evaluation for infectious etiologies was negative. The patient's clinical condition improved over the next 24 h with supportive care. Involvement of the rectum is rare in ischemic colitis because of its abundant collateral blood supply. Acute ischemic proctosigmoiditis should be considered in the differential diagnosis of elderly patients with multiple co-morbidities presenting with hematochezia.

KEY WORDS

proctosigmoiditis ischemia hypotension hematochezia 

Notes

Conflict of Interest

None disclosed.

References

  1. 1.
    Saegesser F, Roenspies U, Robinson JW. Ischemic diseases of the large intestine. Pathobiol Annu. 1979; 9: 303–37.PubMedGoogle Scholar
  2. 2.
    Williams LF Jr, Wittenberg J. Ischemic colitis: a useful clinical diagnosis but is it ischemic? Ann Surg. 1975; 182(4): 439–48.PubMedCrossRefGoogle Scholar
  3. 3.
    Nelson RL, Briley S, Schuler JJ, Abcarian H. Acute ischemic proctitis. Report of six cases. Dis Colon Rectum. 1992; 35(4): 375–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Bharucha AE, Tremaine WJ, Johnson CD, Batts KP. Ischemic proctosigmoiditis. Am J Gastroenterol. 1996; 91(11): 2305–9.PubMedGoogle Scholar
  5. 5.
    Kilpatrick ZM, Farman J, Yesner R, Spiro HM. Ischemic proctitis. JAMA. 1968; 205(2): 74–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Kishikawa H, Nishida J, Hirano E, et al. Chronic ischemic proctitis: case report and review. Gastrointest endosc. 2004; 60(2): 304–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Sharif S, Hyser M. Ischemic proctitis: case series and literature review. The American Surgeon. 2006; 72(12): 1241–7.PubMedGoogle Scholar
  8. 8.
    Alpern MB, Glazer GM, Francis IR. Ischemic or infracted bowel: CT findings. Radiology. 1988; 166(1 Pt 1): 149–52.PubMedGoogle Scholar
  9. 9.
    Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: A comparison of plain films and CT scans in 23 cases. Am J Roentgenol. 1990; 154(1): 99–103.Google Scholar
  10. 10.
    Wiesner W, Mortelé KJ, Glickman JN, Ji H, Khurana B. Ros PR. CT findings in isolated ischemic proctosigmoiditis. Eur Radiol. 2002; 12(7); 1762–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Thorén A, Ricksten SE, Lundin S, Gazelius B, Elam M. Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans. J Auton Nerv Syst. 1998; 68(3): 157–63.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Kumar Abhishek
    • 1
    • 2
  • Shivu Kaushik
    • 1
    • 2
  • Mehdi M. Kazemi
    • 2
  • Samer El-Dika
    • 2
    • 3
    Email author
  1. 1.Department of Internal MedicineCarilion ClinicRoanokeUSA
  2. 2.Department of Internal MedicineVeterans Affairs Medical CenterSalemUSA
  3. 3.VA Medical Center (111G)SalemUSA

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