Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature.

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.