The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Rectal Ischemia Status Post EVAR and COVID-19 

David Farrow 1*, Bryanna Jay1, Sara Stanley2, Anas Renno2, Ali Nawras2 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: david.farrow@utoledo.edu

Published: 05 May 2023 

Introduction: Ischemic proctitis is a rare, but serious, source of GI bleeding as mortality rates approach 
20-40%. Patients for which ischemia should be considered are those with previous surgery, older 
patients, and those with known peripheral arterial disease.

Case Description: 80-year-old male with history of hyperlipidemia and hypertension presented to the 
hospital for shortness of breath secondary to COVID-19 pneumonia. His respiratory status continued to 
decline requiring mechanical ventilation and ICU admission. During his admission, he was found to 
have acute left lower extremity ischemia requiring stenting of his superficial femoral artery and 
abdominal endovascular aneurysm repair (EVAR). He was started on anticoagulation with heparin 
infusion. His hospital course was further complicated large volume maroon-colored stools concerning 
for lower GI bleed. Colonoscopy was performed at the bedside to further evaluate. In the rectum, there 
were circumferential ulcerations with inflammation and exudate, extending 10cm from the anal verge. 
Biopsies were consistent with rectal ischemia.  

Discussion: Rectal ischemia is rare as the rectum has blood supply from the inferior mesenteric and 
bilateral iliac arteries. In our patient, during EVAR graft repair, the IMA was occluded by a stent, the 
iliac arteries however, remained intact providing the middle rectal and pudendal artery as sources of 
collateral blood supply. It is hypothesized that a hypercoagulable state caused by COVID-19 infection 
coupled with ongoing hypotension in the setting of critical illness in our patient with significant 
peripheral arterial disease led to the low flow state in bilateral iliac arteries causing ischemic proctitis. 

https://dx.doi.org/10.46570/utjms.vol11-2023-664 

https://dx.doi.org/10.46570/utjms.vol11-2023-664
mailto:david.farrow@utoledo.edu