A Case of Severe Ischemic Proctitis that Developed in the Remaining Rectum after Hartmann's Procedure

Abstract

An 83-year-old man was admitted to our hospital due to massive rectal bleeding. He had undergone Hartmann's procedure three years earlier at another hospital for sigmoid volvulus. A significant increase in inflammatory markers and worsening renal function were observed on the third day of admission. Emergency colonoscopy from the anus showed extensive necrosis in the remaining rectal mucosa. He was diagnosed as having severe ischemic proctitis, and emergency surgery was performed. Intraoperatively, no necrosis was observed on the serosal surface, and the inferior mesenteric vessels preserved in the previous surgery were intact. The remaining rectum was mobilized as far as possible towards the anal side and resected in the lower rectum as close to the anus as possible. Postoperatively, disruption of the rectal stump caused a pelvic abscess, which improved with transanal drainage. The patient was transferred to another facility on the 31st postoperative day.