Acute colorectal ischaemia after anaphylactoid shock.

Abstract

A 29 year old woman is reported with bloody diarrhoea three hours after developing anaphylactoid shock. Sigmoidoscopy, barium enema, and histology showed rectal and colonic ischaemia to the splenic flexure. Recovery was complete. There was no history of vascular disease but the patient was taking an oral contraceptive. Thirty one other cases of spontaneous ischaemic proctitis are reviewed.

Acute Hemorrhagic Rectal Ulcer Syndrome: A New Clinical Entity? Report of 19 Cases and Review of the Literature

“…Patients with acute ischemic procitis often have clearly identifiable precipitating factors such as aortoiliac operations or shock, and suffer from abdominal pains. 35,36 Lesions are most commonly involved with segmental erythema and edema, with or without ulceration. In AHRUS, however, the surrounding mucosa of the rectal ulcers was either normal or only slightly hyperemic.…”

Anaphylactoid Reaction from IV Contrast Dye Causing Ischemic Colitis with Portal Venous Gas

“…Occlusive ischemia typically involves the descending colon [ 6 ]. This pattern is different than that seen in nonocclusive ischemic states, in which the right side of the colon is involved in the majority of cases [ 7 , 8 ]. Our patient had ascending colonic thickening, supporting a diagnosis of nonocclusive ischemic colitis, which was confirmed on endoscopy.…”

“…In spite of frequent gastrointestinal symptoms such as vomiting, diarrhea, and crampy abdominal pain, mucosal lesions and gastrointestinal ischemia are rarely detected [ 9 ]. There have been 2 cases of gastric mucosal lesions following anaphylaxis [ 9 , 10 ] and 2 cases of anaphylaxis-mediated ischemic colitis and proctitis [ 8 , 9 ]. Animal experimental studies suggest that mucosal anaphylaxis may cause gastrointestinal ulceration, and in fact the gut is the main organ of anaphylactic shock in rats [ 11 – 13 ].…”

Vasovagal Reaction and Ischemic Colitis Following Blood Donation

“…Ischemic colitis is caused by a diminution of the colonic blood supply, resulting from hypotension and hypovolemia, leading to systemic hypoperfusion ( 2 , 3 ). This is the first reported case of ischemic colitis caused by a VVR; however, ischemic colitis caused by hypotension has been reported previously, particularly in cases of anaphylactic shock ( 4 - 6 ). In this case, we did not detect hypotension; nevertheless, a loss of consciousness accompanied by convulsions suggested transient hypotension.…”