Aliyev Vusal, Goksel Suha, Asoglu Oktar
General and Colorectal Surgery, Maslak Acibadem Hospital, Istanbul, TUR.
Pathology, Maslak Acibadem Hospital, Istanbul, TUR.
Cureus. 2021 May 13;13(5):e14998. doi: 10.7759/cureus.14998.
Acute rectal ischemia is a rare entity because the rectum has abundant blood supply from the inferior mesenteric, internal iliac, internal pudendal, and marginal artery with rich collaterals. We present a case of an acute ischemic proctosigmoiditis with a history of rectal cancer who completely recovered after total neoadjuvant treatment and was in the "watch-and-wait" protocol. Urgent laparoscopic low anterior resection and protective ileostomy were performed. Causes of acute rectosigmoid ischemia include old age, diabetes, atherosclerosis, previous aortic surgery due to aneurysm, vasculitis, and radiotherapy. Ischemia may be present as only involving the mucosa, which can be managed conservatively, but full-thickness necrosis requires urgent surgical intervention. Endoscopic examination is the gold standard in initial diagnosis. Ischemic gangrene of the rectosigmoid colon is a rare condition and can be life-threatening unless an urgent surgical intervention is performed.
急性直肠缺血是一种罕见的病症，因为直肠有丰富的血液供应，来自肠系膜下动脉、髂内动脉、阴部内动脉以及具有丰富侧支循环的边缘动脉。我们报告一例急性缺血性直肠乙状结肠炎病例，患者有直肠癌病史，在接受全新辅助治疗后完全康复，并采用“观察等待”方案。实施了紧急腹腔镜低位前切除术和保护性回肠造口术。急性直肠乙状结肠缺血的病因包括老年、糖尿病、动脉粥样硬化、既往因动脉瘤进行的主动脉手术、血管炎和放疗。缺血可能仅累及黏膜，这种情况可保守处理，但全层坏死则需要紧急手术干预。内镜检查是初步诊断的金标准。直肠乙状结肠的缺血性坏疽是一种罕见病症，除非进行紧急手术干预，否则可能危及生命。
