Our Summary

This research paper discusses a rare case of a disease called ischemic proctitis, which is a type of colitis where the rectum becomes inflamed due to insufficient blood supply. The patient, a 60-year-old man with several health issues, including high blood pressure, diabetes, and high cholesterol levels, developed this condition six months after undergoing a surgery called laparoscopic sigmoidectomy to remove a part of his colon because of cancer.

The man started experiencing uncomfortable symptoms like lower abdominal pain, blood in his stools, and a constant need to pass stools. When examined through colonoscopy, he was found to have extensive rectal ulcers, especially severe around the anal area.

Instead of offering another surgery, doctors decided to treat him with hyperbaric oxygen therapy, a non-surgical procedure that involves breathing pure oxygen in a pressurized room or tube. After 48 days of this treatment, the patient’s ulcers healed. He has been free of any recurrence of his symptoms for three and a half years after the treatment.

The researchers conclude that surgeons should be cautious about the blood backflow from the anal side of the bowel while performing a sigmoidectomy. This is especially important for patients who are at a higher risk of developing ischemic proctitis.

FAQs

  1. What is ischemic proctitis and how can it occur after a sigmoidectomy?
  2. What are the symptoms of ischemic proctitis post-sigmoidectomy?
  3. How can ischemic proctitis be managed non-surgically after a sigmoidectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sigmoidectomy is to carefully monitor any symptoms of lower abdominal discomfort, bloody stools, or tenesmus after the surgery. It is important to seek medical attention promptly if any of these symptoms arise, as they could indicate complications such as ischemic proctitis. Additionally, patients with risk factors such as hypertension, diabetes, hyperlipidemia, and smoking should be especially vigilant in monitoring their symptoms and following up with their healthcare provider as needed.

Suitable For

Patients with risk factors for ischemic proctitis, such as hypertension, diabetes, hyperlipidemia, and smoking, may be recommended sigmoidectomy. Additionally, patients with sigmoid colon cancer or other conditions requiring surgery on the sigmoid colon may also undergo sigmoidectomy. It is important to carefully consider the risk factors for ischemic proctitis and monitor patients closely for symptoms post-surgery.

Timeline

  • Before sigmoidectomy: The patient was a 60-year-old man with hypertension, type 2 diabetes, hyperlipidemia, and a history of smoking. He underwent laparoscopic sigmoidectomy for stage I sigmoid colon cancer and was followed up without adjuvant therapy.
  • 6 months after sigmoidectomy: The patient complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy revealed extensive rectal ulcers between the anastomotic site and the anal canal, particularly severe on the anal side several centimeters beyond the anastomosis.
  • Treatment: The patient received non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers healed 48 days after the therapeutic intervention.
  • Follow-up: The patient did not experience any recurrence for 3.5 years post-treatment.

What to Ask Your Doctor

  1. What are the risk factors for developing ischemic proctitis after sigmoidectomy?
  2. How common is ischemic proctitis after sigmoidectomy?
  3. How is ischemic proctitis diagnosed and treated?
  4. What are the potential complications of ischemic proctitis?
  5. Are there any lifestyle changes or medications that can help prevent ischemic proctitis?
  6. How often should I follow up with you after sigmoidectomy to monitor for any potential complications?
  7. Are there any specific warning signs or symptoms I should watch out for that may indicate ischemic proctitis?
  8. Are there any dietary or activity restrictions I should follow after sigmoidectomy to reduce my risk of developing ischemic proctitis?
  9. Are there any support groups or resources available for patients who have experienced ischemic proctitis after sigmoidectomy?
  10. What are the long-term outcomes for patients who develop ischemic proctitis after sigmoidectomy?

Reference

Authors: Yoshida T, Ichikawa N, Homma S, Yoshida T, Emoto S, Miyaoka Y, Matsui H, Taketomi A. Journal: Surg Case Rep. 2021 Feb 22;7(1):54. doi: 10.1186/s40792-021-01133-7. PMID: 33616775