Acute Massive Lower Gastrointestinal Bleeding Secondary to Obstructive Colitis Proximal to Obstructing Cancer of the Sigmoid Colon
Asian Journal of Case Reports in Surgery,
Introduction: Acute massive lower gastrointestinal bleeding (LGIB) is a rare and serious manifestation of obstructive colitis that requires urgent therapeutic intervention. Here, we report a case of LGIB due to obstructive colitis in an adult patient.
Presentation of Case: A 34-year-old man with large bowel obstruction secondary to sigmoid colon cancer underwent laparotomy and Hartmanns procedure (resection of rectosigmoid colon with a proximal end colostomy). Post-operatively, he had recurrent episodes of severe bleeding from the colostomy that required transfusion of a total of eleven units of packed cells and four units of fresh frozen plasma over the next two days. Urgent oesophagogastroduodenoscopy showed pan gastritis and insignificant superficial gastric erosions. Colonoscopy via the colostomy showed stigmata of recent bleed but failed to identify the exact site of bleeding. Computed tomography angiogram failed to localize the site of bleeding. A re-laparotomy was performed. On-table colonoscopy through the end colostomy followed by completion total colectomy and ileorectal anastomosis was done. The patient recovered uneventfully after the surgery with no further episode of rectal bleeding. Histology findings of the resected colon were compatible with obstructive colitis. He remains well at five years follow-up with no recurrence.
Discussion: The case highlights the rare occurrence of acute massive LGIB as a life-threatening complication of obstructive colitis. The diagnosis should be considered in patients who present with large bowel obstruction.
Conclusion: A high index of suspicion is key to early diagnosis and an extended resection of the colon is necessary to arrest bleeding.
- Obstructive colitis
- sigmoid cancer
- intestinal obstruction
- lower gastrointestinal bleeding
- obstructing colon cancer
How to Cite
Chang HK, Min BS, Ko YT, et al. Obstructive Colitis Proximal to Obstructive Colorectal Carcinoma. Asian J Surg. 2009; 32:26–32.
Gratama S, Smedts F, Whitehead R. Obstructive colitis: an analysis of 50 cases and a review of the literature. Pathology. 1995;27:324-329.
Feldman PS. Ulcerative disease of the colon proximal to partially obstructive lesions: report of two cases and review of the literature. Dis Colon Rectum. 1975; 18:601-612.
Rutledge RH. Pseudo-ulcerative colitis proximal to obstructing colon carcinoma. Am Surg. 1969;35:384-388.
Matsunaga H, Shida D, Kamesaki M, Hamabe Y. Acute necrotizing colitis due to sigmoid colon cancer. World J Surg Oncol. 2014;12:19.
Ganchrow MI, Clark, Benjamin HG. Ischemic colitis proximal to obstructing carcinoma of colon. Dis Colon Rectum. 1970;14:38-42.
Harada T, Umezawa I, Mogami K, Itoh A. Acute gangrenous colitis proximal to obstructive cancer of the sigmoid colon. Jpn J Surg. 1975;5:39-47.
Tietjen GW, Markowitz AM. Colitis proximal to obstructing colonic carcinoma. Arch Surg. 1975;110:1133-1138.
Tsai MH, Yang YC, Leu FJ. Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature. Int J Colorectal Dis. 2004;19:268-72.
Levine TS, Price AB. Obstructive enterocolitis: a clinico-pathological discussion. Histopathology. 1994;25:57-64.
Toner M, Condell D, OBriain DS. Obstructive colitis. Ulceroinflammatory lesios occurring proximal to colonic obstruction. Am J Surg Pathol. 1990; 14:719-728.
Stillwell GK. The Law of Laplace. Some clinical applications. Mayo Clin Proc. 1973; 48:863-869.
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