Ischemic Colitis with Perforation Occurring 15 Months after Colorectal Cancer Surgery in a Patient with Severe Heart Failure: A Case Report

TL;DR

A rare case of ischemic colitis leading to perforation 15 months after colorectal cancer surgery in a patient with severe heart failure is reported.

Contribution

This is the first reported case of ischemic colitis with perforation occurring in the late postoperative period after colorectal cancer surgery.

Findings

Ischemic colitis progressed to perforation despite conservative treatment in a patient with severe heart failure.

Emergency surgery was required, including left hemicolectomy and transverse colostomy.

The patient recovered after intensive care and was discharged after 86 days of hospitalization.

Abstract

Ischemic colitis is a common gastrointestinal disorder. However, severe cases requiring surgical intervention are rare. Severe ischemic colitis is particularly uncommon following surgery for colorectal cancer, with a reported incidence of only 0.7%. To our knowledge, there have been no previous reports of ischemic colitis leading to perforation in the late postoperative period following colorectal cancer surgery. Herein, we report a rare case of ischemic colitis that developed following surgery for transverse colon cancer and progressed to colonic perforation despite conservative treatment, ultimately necessitating emergency surgery.

A 60-year-old man with a history of dilated cardiomyopathy, chronic kidney disease, and stage III colorectal cancer underwent laparoscopic anterior resection 15 months prior. The patient presented with lower abdominal pain, hematochezia, and fever. CT and colonoscopy revealed extensive ischemic changes from the descending to the sigmoid colon, leading to a diagnosis of ischemic colitis. The patient’s condition failed to improve despite conservative treatment, and he subsequently developed cerebral infarction and worsening heart failure during hospitalization. In the 6th week of admission, he experienced perforative peritonitis, necessitating high-risk emergency surgery consisting of left hemicolectomy, rectal resection, and transverse colostomy. Pathological examination revealed no malignancy, consistent with the ischemic changes. The patient gradually recovered under intensive care and was discharged on POD 44, after 86 days of hospitalization.

This case highlights the challenges in managing ischemic colitis in patients with severe heart failure after colorectal surgery. Vigilant monitoring and early surgical intervention are crucial for high-risk individuals.

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