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


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.


proctosigmoiditis ischemia hypotension hematochezia 


Conflict of Interest

None disclosed.


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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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