Less-Common Benign Disorders of the Colon and Rectum

Abstract

Vascular disorders of the midgut and hindgut are extremely morbid conditions. This is because these diseases often afflict elderly individuals with various coexisting morbidities and limited physiologic reserve. This is compounded by the fact that these disorders are often diagnosed late, only after full-thickness intestinal injury has occurred, with perforation or gangrene. Major postoperative complications remain excessive and both early and late mortality rates continue to be significant. Ischemic colitis is the most common form of ischemic injury to the gastrointestinal (GI) tract. It is paramount that the surgeon involved in the care of ischemia and hemorrhage of the colon and rectum has a thorough understanding of the anatomy of the large bowel. Ischemic injury to the colon is now recognized to manifest distinct clinical subtypes, ranging in severity from transient segmental colopathy to fulminant gangrenous colitis. Etiologies including shock, autoimmune disease, coagulopathies, long-distance running, illicit drug use, and medication-induced colonic ischemia have been reported, in patients both young and old. Ischemic colitis is often recognized as a specific entity characterized by sudden abdominal pain and diarrhea. A spectrum of disease exists, ranging from transient mucosal injury that spontaneously resolves to transmural disease with full-thickness gangrene. An intermediate form also exists in which, after resolution of symptoms, stricture formation occurs. An increased awareness and suspicion that ischemic colitis is present should initiate prompt diagnostic endoscopy.