Rectal Ischemia Mimicked Tumor Mass

Ischemic proctitis is a rare disease which is usually encountered in elderly with comorbidities. We present a case of an 80-year old man with severe coronary disease who presented with severe hematochezia and hypotension. Endoscopy revealed a rectal mass 3-4？cm above the dental line and rectosigmoid mucosal inflammation compatible with ischemic colitis. The rectal insult was so intense that it resembled a neoplasmatic lesion. We discuss the causes, the prognostic factors, and the clinical and therapeutic challenges of this rare, albeit life-threatening entity, and we review the relative literature. A percentage of 10%–20% of patients with ischemic colitis usually have a distal potentially obstructing lesion or disorder such as cancer, diverticulitis or fecal impaction. Ischemic colitis, when mucosal and submucosal edema is severe and hemorrhagic nodules are large enough, can mimic a neoplasmatic lesion. The best treatment approach is a conservative management initially with a close clinical followup and after stabilization a repetition of rectal endoscopy with new biopsies. Early recognition of this clinical entity is of paramount importance to implement appropriate therapy (conservative or surgical) and avoid potentially fatal treatment of presumed inflammatory or infectious bowel diseases. 1. Introduction Ischemic colitis accounts for 1 in 1000 hospitalizations, but its incidence is underestimated because it usually has a mild and transient nature [1]. The clinical presentation is variable. Most cases of the nongangrenous form are transient and resolve spontaneously without complications. On the other hand, high morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis. Rectal sparing is considered a basic diagnosing feature, which discriminates ischemic colitis from other colitis, since ischemic proctitis is a rare entity [2]. An average of 10–20% of cases are presented as a distal obstructing mass. We present a severe case of ischemic proctitis that was mimicking a rectal cancer. 2. Case Presentation An 80-year old male with end-stage heart failure, severe coronary disease, and mild renal failure presented to our hospital with haematochezia and left sided abdominal pain during the last twenty four hours. Physical examination demonstrated tachycardia, hypotension (BP: 95？mm？Hg), and a slight tenderness of abdominal wall. The ECG did not reveal any arrhythmia. Rectal examination revealed a hard, irregular rectal mass 3-4？cm above the anal verge. The patient was on medication including digoxin,