2018 Volume 38 Issue 1 Pages 117-121
Gangrenous ischemic colitis spreading to the entire colorectum is very rare and few cases have been reported. A 73-year-old male with a previous history of hypertension had abdominal pain and general malaise. On the following day he was admitted to our hospital because of aggravation of his symptoms. Upon arrival he was in a state of shock with severe metabolic acidosis. An abdominal CT scan showed ascites, portal venous gas, thinning of a wide area of the colon wall, and increased density of the adipose tissue around the colon which led to an emergency laparotomy under the diagnosis of bowel necrosis. A gangrenous area of the bowel was observed including 200 cm of the ileum and extending to the upper rectum including the total colon. Furthermore, the mucosal side of the lower rectum demonstrated an ischemic change. Two hundred centimeters of the ileum and the entire colorectum were resected and an ileostomy was carried out. In principle, resection of the necrotic bowel is necessary for gangrenous ischemic colitis and non-occlusive mesenteric ischemia. We resected the entire colorectum due to mucosal necrosis of the lower rectum. We present this case, with as analysis of the pertinent literature regarding gangrenous ischemic colitis spreading to the entire colorectum.
