PASSAGE OF A LARGE-BOWEL CAST CAUSED BY ACUTE-ISCHEMIA - REPORT OF 2 CASES

PURPOSE: We report two cases of spontaneous anal passage of a large bo wel 'cast' caused by acute ischemic injury. METHODS: Clinical, laborat ory, endoscopic, and pathologic features were reviewed, and the litera ture was searched for similar cases. RESULTS: An 85-year-old male who had undergone aortic surgery recovered from rectosigmoid ischemia afte r undergoing a descending colostomy. A 74-year-old male with severe pa ncreatitis 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. CONCLUSION: Passage of a large bowel cast is an e xtraordinary complication of ischemia that often requires diverting su rgery, and most patients survive the ischemic injury.