Ischaemic Colitis Immediately Following Reversal of Leostomy: An Unusual Case

Special Article - Surgical Case Reports

Austin J Surg. 2015;2(3): 1060.

Ischaemic Colitis Immediately Following Reversal of Leostomy: An Unusual Case

Cadoux-Hudson D*, Chand M and Miles AJG

Royal Hampshire County Hospital, UK

*Corresponding author: Daniel Cadoux-Hudson,Royal Hampshire County Hospital, Winchester UK & Royal Marsden Hospital, UK

Received: December 26, 2014; Accepted: May 21, 2015; Published: June 10, 2015


A71-year-old gentleman presented to our care for a reversal of a defunctioning loop ileostomy following an anterior resection for a rectal carcinoma 10 months previously. Post-operatively he developed ileus with worsening pain. Ischaemic colitis was confirmed on flexible sigmoidoscopy. He was discharged 7 days later. There are no reported cases of ischaemic colitis following reversal of ileostomy in the literature, though there are reports of cases occurring after primary resection.

Ischaemic colitis is a rare complication of reversal of defunctioning ileostomy. There is no obvious cause in this case with no significant risk factors for de novo development of disease, or any evidence of compromised perfusion at either procedure. This may have been precipitated by vascular compromise at the initial operation that developed into sub clinical ischaemia whilst the metabolic demands on the colon were minimal. Only once the bowel’s continuity was restored did this become apparent.

Keywords: Ischaemic colits; Reversal of ileostomy; Anterior resection

Case Presentation

A 71-year-old man was admitted for an elective reversal of loop ileostomy. He had previously had a laparoscopic anterior resection with a stapled colorectal anastomosis 10 months earlier for a rectal carcinoma and was left with a defunctioning loop ileostomy. He had subsequently had a three-month course of chemotherapy as 3 lymph nodes were found to be positive in the specimen from the original procedure. He was also found to have a small anastomotic leak during his original admission on Computed Tomography (CT) imaging. This was managed conservatively as he was clinically stable and improved.

At closure of ileostomy it was noted that he had a large parastomal hernia containing 15-20 cm of small bowel necessitating a resection of 8 cm of small bowel with a hand sown end-to-end anastomosis. He had no other significant medical problems other than requiring a Trans Urethral Resection of Prostate (TURP) in the period between his colorectal procedures secondary to benign prostatic hypertrophy.

Post operatively he developed abdominal pain and ileus that was managed with analgesia and insertion of a large bore nasogastric tube. This however did not resolve, and he was started on total parenteral nutrition. An abdominal film showed dilated small and large bowel, though CT did not reveal a transition point. A flexible sigmoidoscopy was ordered for the following day in order to rule out an anastomotic stricture. At endoscopy an area of ulceration consistent with ischaemia was seen in his colon 50cm from the anal verge. There was no evidence of recurrence or an anastomotic stricture. He remained in hospital for a further 7 days with symptoms of ongoing cramping abdominal pain and increased frequency of bowel habit. He has since been seen in follow up and continues to have a more frequent bowel habit, though the pain is significantly improved (Figures 1 & 2).

Citation: Cadoux-Hudson D, Chand M and Miles AJG. Ischaemic Colitis Immediately Following Reversal of Leostomy: An Unusual Case. Austin J Surg. 2015;2(3): 1060. ISSN: 2381-9030.