Passage of a large bowel cast caused by acute ischemia

Abstract

We report two cases of spontaneous anal passage of a large bowel 'cast' caused by acute ischemic injury. Clinical, laboratory, endoscopic, and pathologic features were reviewed, and the literature was searched for similar cases. 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. Passage of a large bowel cast is an extraordinary complication of ischemia that often requires diverting surgery, and most patients survive the ischemic injury.