Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature
Abstract Background Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon. Case presentation This report describes a patient with a hist...
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| Format: | Article |
| Language: | English |
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BMC
2025-03-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-025-03387-w |
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| author | Yimei Lin Jingyi Wu Junmei Wu Juanlan Liu Chao Liang |
| author_facet | Yimei Lin Jingyi Wu Junmei Wu Juanlan Liu Chao Liang |
| author_sort | Yimei Lin |
| collection | DOAJ |
| description | Abstract Background Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon. Case presentation This report describes a patient with a history of CAS and percutaneous coronary angioplasty (PTCA) who experienced coronary artery spasm and subsequent cardiac arrest during anal anastomosis in a transabdominal perineal radical resection of rectal cancer (MILES procedure). Conclusion This case study offers significant insights into the pathophysiology of cardiac arrest induced by surgical intervention in the anal region, which is densely innervated by the vagus nerve at the terminal portion of the rectum. This phenomenon may be associated with the anal cardiac reflex and vagus nerve reflexes. It is imperative to recognize the potential for catastrophic outcomes due to vagus nerve excitation during rectal end surgery, particularly in patients with a history of acute CAS. |
| format | Article |
| id | doaj-art-4e284ed0f9f14b94a8b5ac4e2f0f8864 |
| institution | OA Journals |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-4e284ed0f9f14b94a8b5ac4e2f0f88642025-08-20T02:17:52ZengBMCJournal of Cardiothoracic Surgery1749-80902025-03-012011710.1186/s13019-025-03387-wAnal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literatureYimei Lin0Jingyi Wu1Junmei Wu2Juanlan Liu3Chao Liang4Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan UniversityDepartment of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan UniversityDepartment of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan UniversityDepartment of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan UniversityDepartment of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan UniversityAbstract Background Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon. Case presentation This report describes a patient with a history of CAS and percutaneous coronary angioplasty (PTCA) who experienced coronary artery spasm and subsequent cardiac arrest during anal anastomosis in a transabdominal perineal radical resection of rectal cancer (MILES procedure). Conclusion This case study offers significant insights into the pathophysiology of cardiac arrest induced by surgical intervention in the anal region, which is densely innervated by the vagus nerve at the terminal portion of the rectum. This phenomenon may be associated with the anal cardiac reflex and vagus nerve reflexes. It is imperative to recognize the potential for catastrophic outcomes due to vagus nerve excitation during rectal end surgery, particularly in patients with a history of acute CAS.https://doi.org/10.1186/s13019-025-03387-wMILES surgeryAnal-cardiac reflexCardiac arrestCoronary artery spasm |
| spellingShingle | Yimei Lin Jingyi Wu Junmei Wu Juanlan Liu Chao Liang Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature Journal of Cardiothoracic Surgery MILES surgery Anal-cardiac reflex Cardiac arrest Coronary artery spasm |
| title | Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature |
| title_full | Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature |
| title_fullStr | Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature |
| title_full_unstemmed | Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature |
| title_short | Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature |
| title_sort | anal cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum miles case report and review of the literature |
| topic | MILES surgery Anal-cardiac reflex Cardiac arrest Coronary artery spasm |
| url | https://doi.org/10.1186/s13019-025-03387-w |
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