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ACUTE ISCHEMIC PROCTITIS IN A YOUNG PATIENT WITH CONSTIPATION

Gilberto Herrera Quiñones 1,2,3, Maria Fernanda Contreras Chong 2, Cecilia Fernanda Peña Puga 2, Carlos Isao Felix Saguchi 4, Gildardo Herrera 5

Affiliations

1 Mexican Institute of Social Security (IMSS), Mexicali, Mexico

2 Universidad Autonoma de Baja California, Mexicali, Mexico

3 Hospital Almater, Mexicali, Mexico

4 ISSSTE Hospital 5 de Diciembre, Mexicali, Mexico

5 Centro de Estudios Universitarios Xochicalco, Mexicali, Mexico

Summary

AI Generated

A 30-year-old female with acute appendicitis and severe constipation developed post-operative ischemic proctitis secondary to stercoral colitis, an extremely rare complication with only 6 prior reported cases.

The patient initially presented with 3-day constipation, acute abdominal pain, and SIRS; CT showed appendicitis with abundant fecal matter throughout the colon and appendectomy was performed
Two days post-discharge the patient developed sepsis, hematochezia, and anal pain; colonoscopy confirmed ischemic proctitis with large hemorrhagic ulcerations
Treatment with intravenous broad-spectrum antibiotics, IV fluids, and NPO resulted in rapid improvement with complete resolution of symptoms
Ischemic colitis of the rectum secondary to stercoral colitis results from increased intraluminal pressure and carries reported mortality rates up to 35%
This case report contributes to very limited literature and demonstrates successful management using ischemic colitis guidelines adapted to individual patient circumstances

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

We present a case of a 30-year-old female admitted to the emergency room with a 3-day history of constipation, acute abdominal pain, and rebound tenderness. Her vital signs and laboratory findings corresponded to a systemic inflammatory response (SIRS). The abdominal CT scan with intravenous contrast reported acute appendicitis associated with intraperitoneal fluid and abundant fecal matter throughout the colon. Appendectomy was performed. After surgery, the patient developed diarrhea. The patient was discharged asymptomatic. After two days she developed sepsis, hematochezia, anal pain. A colonic ischemia was suspected and rectosigmoidoscopy with biopsies was performed showing large hemorrhagic ulcerations, CT scan, and MRI showed proctitis. The patient was managed with intravenous broad-spectrum antibiotics, IV fluids, and NPO with rapid improvement. Five days later a colonoscopy was performed showing ischemic proctitis. The patient remained asymptomatic and SIRS resolved. She was discharged and remains asymptomatic. Ischemic colitis of the rectum secondary to stercoral colitis is a rare complication as a result of increased intraluminal pressure. Due to their narrower diameter sigmoid colon and rectosigmoid colon are the most common areas affected. It is an entity that must be diagnosed and managed urgently because of the reported mortality rates of up to 35%. Intestinal perforation and solitary stercolar ulcers are the most common complications. Ischemic colitis due to constipation is an extremely rare entity. Until now, only 6 cases have been reported. Due to the limited literature on this complication, management must be individualized. We used ischemic colitis guidelines to treat this case and obtained an excellent outcome.

References

1. Hung A, Calderbank T, Samaan MA, Plumb AA, Webster G. Ischaemic colitis: Practical challenges and evidence-based recommendations for management. Vol. 12, Frontline Gastroenterology. BMJ Publishing Group; 2021. p. 44–52.
2. Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ. ACG clinical guideline: Epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Vol. 110, American Journal of Gastroenterology. Nature Publishing Group; 2015. p. 18–44.
3. Azimuddin K, Raphaeli T. Acute ischemic gangrene of the rectum: Report of 3 cases and review of literature. Int J Surg Case Rep. 2013;4(12):1120–3.
4. Uwagbale E, Bodiwala V, Agbroko S, Bigajer E. A Case of Stercoral Colitis Complicated by Ischemic Colitis in a Young Patient. Cureus. 2022 Jun 17;
5. Naseer M, Gandhi J, Chams N, Kulairi Z. Stercoral colitis complicated with ischemic colitis: A double-edge sword. BMC Gastroenterol. 2017 Nov 28;17(1).

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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