Extensive Rectal Ischemia with Perforation: A Rare Case of Whole-Segment Ischemic Injury

Background and Clinical Significance: Extensive rectal ischemia is exceptionally rare due to the rectum’s robust vascular network, with segmental ischemia being more common. Case Presentation: We report the case of a 69-year-old female who presented with whole-segment rectal ischemia, encompassing the upper, mid, and lower rectum. This severe local ischemic event culminated in full-thickness perforation and extensive fecal peritonitis, which subsequently precipitated postoperative septic shock. The patient underwent emergency low anterior resection with Hartmann’s procedure and received intensive multidisciplinary postoperative care. Conclusions: In this case, we aimed to highlight the importance of early recognition, decisive surgical intervention, and the pathophysiological and diagnostic challenges in managing rare cases of whole-segment rectal ischemia.