Venous Congestive Ischemic Colitis After Sigmoid Colectomy: A Case Report

• Published in: Cureus Vol. 16; no. 2; p. e53880
• Main Authors: Ishimaru, Naoki, Tagami, Takashi, Takayasu, Kohei
• Format: Journal Article
• Language: English
• Published: United States Springer Science and Business Media LLC 08.02.2024; Springer Nature B.V; Cureus
• Subjects: Abdomen; Cancer surgery; Case reports; Colonoscopy; Colorectal cancer; Colorectal surgery; Diabetes; Dissection; Emergency medical care; Erythema; General Surgery; Hospitals; Inflammatory bowel disease; Ischemia; Lymphatic system; Mesentery; Patients; Surgical anastomosis; Thrombosis; Tomography; Veins & arteries; colorectal surgery; inferior mesenteric vein; ischemic colitis; venous congestion; mesenteric artery
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.53880

Venous congestion is a possible cause of ischemic colitis following colorectal surgery. As such, congestive ischemic colitis should be considered in such cases where the mesenteric artery is preserved. Herein, we describe the case of a 73-year-old man who presented to the hospital with a two-week history of difficult defecation and frequent mucous stools and was subsequently diagnosed with refractory ischemic enterocolitis due to venous congestion. The patient had undergone resection of the sigmoid colon cancer with preservation of the inferior mesenteric artery 11 months before presentation. Contrast-enhanced abdominal computed tomography revealed edematous wall thickening on the anal side of the anastomosis. A colonoscopy revealed a normal mucosa extending from the anastomosis to the descending colon; however, mucosal swelling, erythema, and erosion were observed on the rectal side of the anastomosis. Based on these findings, he was diagnosed with ischemic colitis. After two months of ineffective conservative treatment, the patient underwent surgery. Ischemic colitis was diagnosed as venous congestion based on the histopathological examination. Preservation of the mesenteric artery may result in ischemic colitis due to an imbalance between the arterial and venous blood flow. Chronic ischemic colitis due to venous congestion should be considered in cases of mesenteric artery preservation to reduce anastomotic leakage.