Overview
Sigmoid colon ulcers can arise from various etiologies including ischemia, inflammatory bowel disease, malignancy, and complications from surgical interventions or radiotherapy 23. These ulcers may present with significant morbidity and require careful management to prevent complications such as fistulas.Diagnosis
Clinical Presentation: Abdominal pain, rectal bleeding, and altered bowel habits 2.
Endoscopic Evaluation: Essential for visualizing ulcer characteristics and assessing extent 2.
Imaging: CT or MRI may be used to evaluate complications like fistulas or abscesses 2.
Laboratory Tests: CBC, coagulation profile, and inflammatory markers to assess severity 2.Management
Medical Management: Address underlying causes (e.g., anticoagulation reversal, inflammatory control) 2.
Surgical Intervention: Indicated for complications like fistulas, perforations, or refractory cases 3.
Embolization: For managing arterial fistulas, as demonstrated in cases of hypogastric artery-vaginal fistulas 3.Special Populations
Postoperative Patients: Increased risk of complications like pressure-related leg issues; monitor lower leg pressures during surgery 2.
Radiation Therapy History: Higher risk of developing complications such as fistulas; close surveillance required 3.Key Recommendations
Monitor Intraoperative Leg Pressures: Regularly monitor and adjust positioning to prevent complications in lithotomy position during sigmoid colon surgery (Evidence: Moderate) 2.
Endoscopic Surveillance: Utilize endoscopic evaluation for diagnosis and monitoring of sigmoid colon ulcers (Evidence: Moderate) 2.
Consider Embolization for Malignant Fistulas: In cases of arterial-vaginal fistulas following pelvic radiotherapy, embolization can be an effective intervention (Evidence: Weak) 3.References
1 Miguel IM, Muñoz D, Lupo C, Alcaraz BJ. Absence of association between serve and winning point in professional padel. The Journal of sports medicine and physical fitness 2024. link
2 Kajitani R, Minami M, Kubo Y, Iwaihara H, Takishita Y, Isayama M et al.. Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position. Surgical endoscopy 2022. link
3 Kim CR, Randall CL. Hypogastric arterial-vaginal fistula following multiple surgeries and pelvic radiotherapy. Gynecologic oncology 1992. link90236-c)