A CASE OF ACUTE NECROTIC INTESTINAL ISCHEMIA WITH A RECTAL CANCER

A case of acute necrotic intestinal ischemia with a rectal cancer is described. A 63-year-old woman was admitted to the hospital because of constipation and abdominal pain with an episode of bloody stool. A rectal cancer was detected by clinical examination, but no other significant changes were seen in the colonic mucosa. After administration of a preoperative laxative, severe abdominal pain occurred. On laparotomy, extensive necrotic bowel ischemia revealed in the colon. Rectosigmoidectomy, total colectomy and ileostomy were performed. But, after massive colectomy this patient died of ischemic necrosis of the lower part of the ileum. Pulsation of the main mesenteric artery and of colonic arterial arcade were preserved at the time of surgical operation. Histological examination showed that multiple fresh fibrin thrombus were observed in mucosal or submucosal small vessels. We think that complicated combination of the vascular and intestinal factors might contribute to the pathogenesis in this case.