Presentation
The patient underwent low anterior resection for rectal cancer five days before. She underwent repeat surgery the day after the first surgery with clinical signs of peritonitis due to anastomosis failure. On the 4th post-op day, she was again referred for a CT scan because of tachycardia and minimal acidosis but without leukocytosis or abdominal complaints.
Patient Data
Evidence of sigmoid and upper rectal resection, an ileostomy in the right side, and colostomy on the left side is seen as well as moderate ascites. A surgical drain passing open-ended distal rectum to the presacral area and another abdominal drain ending in the upper presacral region are seen too. A 15 cm long segment of the colon just upstream from the colostomy did not show normal mural enhancement with a sharp demarcation.
There is also prominent ring artifact.
The red arrows point the ischemic colon, lacking normal mural enhancement. The yellow line depicts normal colon with enhancing wall. The sharp demarcation indicates a vascular process.
The photo shows the colostomy site, which has an abnormal color in favor of necrosis.
Case Discussion
On the second surgery, gangrene of a 15 cm long segment of the colon up to colostomy site was found. During resection of the rectum and sigmoid, the corresponding vascular pedicle was ligated, and the corresponding length of the colon should be resected. In this case, the colectomy did not include a segment with impaired blood supply, which progressed to transmural necrosis in few next days.
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