A 71-year-old man presented with fever in the ICU after an episode of dyspnea, hypotension and desaturation, with fever of up to 39.5°C. He was diagnosed with septic shock in relation to infectious colitis.
Upon admission to the unit, treatment with vasoactive drugs (noradrenaline 0.1 ugr/kg/min and dopamine 6 ugr/kg/min) and coverage with broad-spectrum antibiotics were initiated.
A few hours after arrival to the ICU, the patient begins to make abundant melenic stools.
A Flexi-Seal FMS device was placed to facilitate accurate assessment of fecal volume and fecal appearance.
This device was kept in place for 6 days without the appearance of any complication, being removed after the fecal volume and increased consistency.
On the 8 day at the unit, enteral nutrition is started, with poor tolerance by the patient, performing several daily stools although in small quantity.
In addition, once the episode of gastrointestinal bleeding was treated, antithrombotic prophylaxis was initiated with enoxaparin 40 mg/day subcutaneously.
On day 25 after removal of the device, the patient suddenly starts with two episodes of severe rectal bleeding without hemodynamic instability.
An emergency catheter is inserted, in which the existence of a normal mucosa is observed up to the distal rectum, where an ulceration is observed, covering half of the circumference, ulceration due to fibrin deposits and areas of necrosis.
