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KMID : 0374920170380010059
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Inje Medical Journal
2017 Volume.38 No. 1 p.59 ~ p.66
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A Case of Chronic Isolated Ischemic Proctitis in Patient with Bowel Obsession Syndrome
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Kim Young-Moon
Park Ji-Young
Jeon Tae-Joo
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Abstract
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A 49-year-old woman presented to the hospital with bloody stool and proctalgia for two months. She had psychiatric history of obsessive compulsive disorder. From the age of 30, she had felt fullness at the anus and tenesmus, often resulting in excessive straining and need to digitally reduce the rectum to help push stool out of the rectum at least three times a day. Rectal examination revealed painful hard mucosa. Colonoscopy showed large geographic ulcers covered with exudate and peripheral erythematous mucosa in the anterior rectal wall approximately 5 cm of the anal verge. The mucosa proximal to the ulcers was intact. Sigmoidoscopy four months later revealed a huge mass-like mucosa with edematous surface 5 cm above the anal verge. Histology of the biopsy specimen obtained from colonoscopy demonstrated focal loss of epithelial cells and glands, superficial epithelial necrosis, destructions of vessels and thrombosis of the veins consistant with chronic ischemia. The patient was diagnosed with ischemic proctitis caused by high pressure within the rectum during defecation and persistant irritation of the rectum by enemas and fingers leading to mucosal ischemia. She is steadily improving under long-term biofeedback and behavioral therapy for bowel obsession syndrome.
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KEYWORD
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Bowel obsession syndrome, Ischemic proctitis, Obsessive compulsive disorder, Defecation
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