ABSTRACT

Introduction:

Ischemic colitis after colorectal surgery is a rare and serious clinical complication. Pneumoperitoneum is blamed for postoperative colonic ischemia. Nowadays, as the laparoscopic techniques are preferred, this complication has been seen more frequently.

Presentation of case:

We report the case of a 62 year old male with proximal colonic ischemia following laparoscopic rectal surgery. Proximal bowel necrosis and re-operations are the most common clinical scenario. We present here a non-operative treatment and clinical features of postoperative colonic ischemia.

Discussion:

Colonic ischemia is a clinicopathological condition from reversible colopathy and transient colitis to gangrenous and fulminant colitis. In this case, high ligation of IMA (Inferior mesenteric artery) for upper rectum surgery, mesentery traction or high pressure pneumoperitoneum during laparoscopy might have triggered ischemic colitis in proximal part of the anastomosis. Excluding the anastomotic dehiscence and peritonitis has encouraged us for being more conservative in our treatment.

Conclusion:

Colonic ischemia following a colorectal surgery and its possible clinical features has not been well described yet. Therefore acute abdominal pain after colorectal surgery should be evaluated immediately. Ischemic colitis should always be kept in mind after colorectal surgery. If there is no peritonitis or anastomotic leakage, segmental colonic ischemia can be treated nonsurgically.