Passage of a large bowel cast caused by acute ischemia: report of two cases.
OBJECTIVE
We report two cases of spontaneous anal passage of a large bowel 'cast' caused by acute ischemic injury.


METHODS
Clinical, laboratory, endoscopic, and pathologic features were reviewed, and the literature was searched for similar cases.


RESULTS
An 85-year-old male who had undergone aortic surgery recovered from rectosigmoid ischemia after undergoing a descending colostomy. A 74-year-old male with severe pancreatitis developed a postischemic sigmoid stricture but did not have operative treatment before death of pneumonia three months after the episode. A literature review revealed six cases of passage of a large bowel cast. In the eight total patients, infarcted muscularis propria was found in seven specimens, five patients had a diversion procedure, and seven survived.


CONCLUSIONS
Passage of a large bowel cast is an extraordinary complication of ischemia that often requires diverting surgery, and most patients survive the ischemic injury.
Ardigo
G J
GJ
Department of Medicine, Kaiser Permanente Medical Care Program, San Diego, California, USA.
Longstreth
G F
GF
Weston
L A
LA
Walker
F D
FD
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017091:Colitis, Ischemic / Q000209:etiology / Q000473:pathology*; D003106:Colon / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D007238:Infarction / Q000473:pathology / Q000601:surgery; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D011183:Postoperative Complications