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

Sep 29, 2026

Uploaded by Mabel

Ischemic colitis is an uncommon but serious gastrointestinal disorder, especially after colorectal cancer surgery, and perforation in the late postoperative period is exceedingly rare. This case report describes a 60-year-old man with severe heart failure who developed ischemic colitis following surgery for transverse colon cancer and progressed to colonic perforation despite conservative management. The patient underwent high-risk emergency surgery after worsening clinical status and recovered with intensive care.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Case Presentation

Diagnostic findings and initial management

Emergency surgery and outcomes

Conclusions

SURGICAL CASE REPORTS Surg Case Rep 2025; 11: 25-0566 Case Report Ischemic Colitis with Perforation Occurring 15 Months after Colorectal Cancer Surgery in a Patient with Severe Heart Failure: A Case Report Ryosuke Machi , Daisuke Yamamoto , Haruka Kubo, Shunsuke Takenaka, Hiroyuki Tanaka, Kazuyoshi Mitta, Hiroshi Saito , Kenta Doden , Yusuke Sakimura, Kengo Hayashi , Saki Hayashi , Ryota Matsui , Hiroto Saito, Toshikatsu Tsuji , Hideki Moriyama, Jun Kinoshita, and Noriyuki Inaki ABSTRACT INTRODUCTION: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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. KEYWORDS: ischemic colitis, colorectal cancer, postoperative complications, colonic perforation, heart failure Department of Gastrointestinal Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan Corresponding author: Daisuke Yamamoto. Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan [E-mail: yamamoto.daisuke@gmail.com](E-mail: yamamoto.daisuke@gmail.com) Received: September 12, 2025; Accepted: November 20, 2025 DOI: 10.70352/scrj.cr.25-0566 © 2025 The Author(s) . Published by Japan Surgical Society This article is licensed under a Creative Commons Attribution 4.0 International License. Machi R. et al. Abbreviations AcMCA accessory middle colic artery CAPOX capecitabine and oxaliplatin CRP C-reactive protein IMA inferior mesenteric artery IMV inferior mesenteric vein Lt-MCA left branch of the middle colic artery SMA superior mesenteric artery UICC Union for International Cancer Control INTRODUCTION Ischemic colitis is an acute intestinal ischemic disease characterized by the sudden onset of abdominal pain and hematochezia. It accounts for approximately 16.0%–19.3% cases of acute lower gastrointestinal bleeding, and is a common cause of acute abdomen encountered in clinical practice. 1–3) Its pathophysiology is multifactorial, involving both vascular and intestinal factors. Although patients who have undergone surgery for colorectal cancer possess both types of risk factors, the incidence of ischemic colitis in this population remains rare, reported at only 0.7% .4) Moreover, to our

FAQs

Why is late postoperative ischemic colitis with perforation after colorectal cancer surgery rare?

The report explains that severe ischemic colitis requiring surgery is uncommon, and perforation in the late postoperative period after colorectal cancer surgery has not been previously reported, with ischemic colitis incidence in this population reported as only 0.7%.

What symptoms and diagnostic results led to the diagnosis of ischemic colitis?

The patient presented with lower abdominal pain, hematochezia, and fever. CT and colonoscopy showed extensive ischemic changes from the descending to the sigmoid colon, supporting a diagnosis of ischemic colitis.

What treatment was required after conservative management failed?

When the condition did not improve under conservative treatment and the patient developed perforative peritonitis, high-risk emergency surgery was performed, including left hemicolectomy, rectal resection, and transverse colostomy.

Sep 29, 2026

Uploaded by Mabel