Idiopathic rectal necrosis in 72-year-old women: report of a case and a literature review.

Rectal necrosis is a rare pathology, with little reports published in the literature. There are nonspecific symptoms, but clinical course may be dramatic, with necessity of urgent surgery and intensive care. A 72-year-old female was admitted to hospital with complaints of bloody stool and dull abdominal pain. Symptoms started one week before and aggravated progressively. Physical examination revealed abdominal tenderness and flatulence, with no signs characteristic for peritonitis. Digital rectal examination demonstrated ulceration on the anterior rectal wall. Laboratory tests showed anemia, hypokalemia and elevated inflammatory parameters, whereas stool cultures revealed presence of Salmonella. During endoscopy, large rectal narrowing has been demonstrated. Because of this lesion and deteriorated clinical state, patient was qualified to urgent surgery. Necrotizing changed rectum has been observed intraoperatively. Additionally, extensive ischemia of the colon was present. Surgeons decided to perform proctocolectomy with end ileostomy. Although rectal necrosis occurs greatly seldom, it can be associated with life-threatening clinical course. Symptoms of this entity are untypical and it is easy to misdiagnose patient with necrosis of the rectum. Treatment of necrotic rectal injury is predominantly surgical and consists in segmental bowel resection.