• PDF / 142,251 Bytes
• 1 Pages / 623.591 x 841.847 pts Page_size
• 104 Downloads / 152 Views

DOWNLOAD

REPORT

---

1

S

Rectal necrosis following sclerotherapy, and acral necrosis following catecholamines: case report A 43-year-old man developed life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids; he then experienced acral necrosis leading to amputation of his toes after he was treated with catecholamines. The man underwent local endoscopic sclerotherapy [specific drug and dosage not stated], and presented to an emergency department with diffuse lower abdominal pain, diarrhoea and a mildly elevated temperature the following day. He had a normal WBC count and a CRP level of 19.1 mg/L, and he was hospitalised for diagnosis and treatment. His fever and abdominal pain worsened the next day, and his CRP level and WBC count increased. An abdominal CT scan showed rectal wall oedema and small amounts of fluid throughout his abdominal cavity. Circumscribed longitudinal, nonconfluent necrosis of his rectal mucous membrane was evident on sigmoidoscopy. An explorative laparotomy showed no pathology of his sigmoid colon 24 hours postadmission. He was transferred to an ICU, and developed severe septic shock soon after. A second sigmoidoscopy disclosed progression of necrosis and oedema. A fulminant necrotic infection of the rectum was diagnosed. Within 48 hours of admission, the man underwent a Hartmann operation with resection of the rectum and parts of his sigmoid colon. He was transferred to the SICU for severe septic shock and started receiving high-dose catecholamines [drugs and dosages not stated]. Clinical complications included acute renal failure requiring continuous haemofiltration, and tracheotomy for improved ventilation. Septic shock persisted for almost 10 days. Secondary to catecholamine therapy, he developed acral necroses on both hands and feet [duration of treatment to reaction onset not stated]. After 4 weeks of ICU treatment, he was transferred to a ward. Almost 4 weeks later, he was able to walk the corridors and eat normal food; his colostomy and renal function were normal. However, necroses on his feet did not heal, and he required amputation of all toes. He was discharged after almost 3 months. Intestinal continuity was restored 8 months later, and the ileostomy was closed 1 year and 2 months after the Hartmann procedure. Author comment: "To the best of our knowledge, the described case of fulminant isolated necrotic infection of the rectum after endoscopic sclerotherapy without encroaching the surrounding soft tissue is the first one reported in literature." Schulte T, et al. Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. International Journal of Colorectal Disease 23: 725-726, No. 7, Jul 801111463 2008 - Germany

0114-9954/10/1207-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Reactions 21 Jun 2008 No. 1207