W H I L E THE literature describing the ischemic colon co ntains isolated reports of rectal in vol v ement (6,8), larger ser ies hav e n ot a lways included this segm ent of bowel involvement (5, 7), an d, even when demonstrated on co n t rast examination, the fa ct of rectal in volv em ent has not been st ressed (2) . T h is ha s frequently led t o mistaken di agnoses of ulcerative colitis.When the blood su p p ly to the colon is compromised as a r esult of changes in t he vasculature due t o local reasons (t hrombosis, em b olism) or secon dary t o remote causes (sh ock , co ngest ive heart failure, hemorrha ge) (4) , ischemic damage m ay follow. R adiological evidence of these changes include mucosal edema, ulceration, spasm, and submucosal hemorrhage (2, 7). Frank infarction and ev en gan gre n e of the colon have resulted from se ve re impairment of the blood su pp ly (8) . With healing, narrowing of the bowel due to st rict ure formation as well as sacculat ion may result (5,8).W e ha v e st u d ied 9 ca ses of rectal involvemen t due to ischemia. The find ings in all cases were present clinically , radiologically , a n d pathologically . This presen t at ion will em phasize the radiolog ica l findings.MAT ERIALS AND METHODS E ight pat ien ts were male, and one wa s female. The ages ranged fr om sixty-two to eighty-six years; the avera ge was seventy-one. Eight p atients underwent sigm oidosco p ic examin at ion and rectal biopsy .P ost m or tem con fir mation was ob tained in the ninth case. A bari um enema exam inat io n wa s performed in all ca ses excep t one, in which H ypaque was preferred . Arteriography was undertaken in on e in stance. CASE I : B. R, a 74-y ea r -ol d w hi te m a n , w a s admitted because of a two-day h is t ory of pain in the Fig. 1. CASE 1. Hypaque enema examinat ion . "Th u m b prin t " indentations present in t he rectu m a nd sig moid. Fi g. 2 . C ASE II . Barium enema exami nation. M a rked ir reg ularity of the rectal wall d ue t o ulc erati on and m ucosa l swell ing. 1 F rom thc D ep artmen t s of R ad iolo gy (J. F ., Assi stant P rofessor; E . B ., I n struc t or ) and Gastroen terology (Z. M. K ., fo rmerly Post -doctoral Fellow ), Yale Unive rsi ty School of Medicine a nd the Radiologic Se rv ice YaleXew H a v en Hospital, New H aven , Conn . Accepted for publication in February 1968. ' 2 P resently, A ssist ant P rofessor of M ed icin e,
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