Bharucha A E, Tremaine W J, Johnson C D, Batts K P
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA.
Am J Gastroenterol. 1996 Nov;91(11):2305-9.
Rectal ischemia is rare because of excellent collateral supply. Although rectosigmoid ischemia is usually accompanied by more proximal colonic involvement, it may occur alone.
A retrospective review of all patients diagnosed as having colonic ischemia at the Mayo Clinic from 1976 to 1991 was performed. Clinical, endoscopic, radiological, and pathological data were obtained from patient charts. Patients with involvement of the rectosigmoid colon extending to no more than 30 cm above the dentate line on endoscopy were included in the study. A single radiologist reviewed CT scans and aortograms, and a single pathologist reviewed tissue specimens.
Ten of 328 patients with ischemic colitis had isolated ischemic proctosigmoiditis. Six patients had acute ischemia (i.e., symptom duration of less than 4 wk), and four had chronic ischemia (symptoms for 4 wk or longer). Ischemic proctosigmoiditis affects elderly patients with atherosclerosis. An identifiable precipitating factor, such as a major illness or hemodynamic disturbance, was identified in four of six patients with acute ischemic proctosigmoiditis and in one of four patients with chronic ischemic proctosigmoiditis. CT revealed rectal wall thickening and/or perirectal stranding. Angiography may demonstrate atheromatous disease of the aortoiliac vessels. Acute and "chronic" presentations had similar histopathological changes.
Ischemic proctosigmoiditis is rare. In contrast to generalized colonic ischemia, patients with acute rectal ischemia often have clearly identifiable precipitating factors. Conservative management is appropriate for uncomplicated acute ischemic proctosigmoiditis. Patients with chronic ischemic proctosigmoiditis. Patients with chronic ischemic proctosigmoiditis may develop bowel perforation necessitating a proctectomy or colonic diversion. Recognition of this entity and differentiation from idiopathic inflammatory bowel disease is important to determine appropriate therapy.
由于丰富的侧支循环供应，直肠缺血很少见。虽然直肠乙状结肠缺血通常伴有更靠近近端的结肠受累，但也可能单独发生。
对1976年至1991年在梅奥诊所诊断为结肠缺血的所有患者进行回顾性研究。从患者病历中获取临床、内镜、放射学和病理学数据。内镜检查显示直肠乙状结肠受累范围不超过齿状线以上30厘米的患者纳入研究。由一名放射科医生审查CT扫描和主动脉造影，一名病理科医生审查组织标本。
328例缺血性结肠炎患者中有10例患有孤立性缺血性直肠乙状结肠炎症。6例为急性缺血（即症状持续时间少于4周），4例为慢性缺血（症状持续4周或更长时间）。缺血性直肠乙状结肠炎症影响患有动脉粥样硬化的老年患者。在6例急性缺血性直肠乙状结肠炎症患者中有4例以及4例慢性缺血性直肠乙状结肠炎症患者中有1例可识别出明确的诱发因素，如重大疾病或血流动力学紊乱。CT显示直肠壁增厚和/或直肠周围条索状影。血管造影可能显示主动脉髂血管的动脉粥样硬化病变。急性和“慢性”表现具有相似的组织病理学变化。
缺血性直肠乙状结肠炎症很少见。与广泛性结肠缺血不同，急性直肠缺血患者通常有明确可识别的诱发因素。对于无并发症的急性缺血性直肠乙状结肠炎症，保守治疗是合适的。慢性缺血性直肠乙状结肠炎症患者可能会发生肠穿孔，需要进行直肠切除术或结肠改道。认识到这一实体并与特发性炎症性肠病相鉴别对于确定合适的治疗方法很重要。
