On the Pathogenesis of Acute Ischemic Proctitis

Excerpt

To the Editor—I enjoyed reading the article by Maun et al. who reported on four cases of acute ischemic proctitis (AIP).1 They mentioned that the condition is mainly described in patients with significant atherosclerosis and cardiac risk factors. They presented four cases of AIP that required proctectomy. We previously reported on AIP caused by pudendal artery syndrome.2 The patients showed common clinical and investigative findings, which included anal pain and bleeding, and tender, edematous, and ulcerated anal canal. Selective pudendal arteriography revealed obliteration of the distal part of the internal pudendal artery (IPA), which corresponded to the part in the pudendal canal. Arteriography did not show the picture of atherosclerosis. Manifestations of pudendal neuropathy and pudendal canal syndrome were present and comprised of perineal hypoesthesia, reduced levator, and external anal sphincter EMG activity, prolonged pudendal nerve terminal motor latency, as well as stress urinary and fecal incontinence. The aforementioned pathologic process was localized to the anal canal, whereas the rectum and colon were free. The nonvisualization of the distal part of IPA and inferior rectal arteries on both sides suggested that this proctitis is ischemic. Pudendal canal decompression, by releasing the pudendal vessels from being entrapped in the pudendal canal, effected the disappearance of the symptoms and healing of the anal lesions in the three patients. …