Abstract
A 65-year-old man who had been under hemodialysis reported a high fever and abdominal pain from the day before he came to our hospital, where he was diagnosed as having a gastrointestinal perforation. Emergency laparotomy revealed a perforation of the sigmoid colon diverticulum, and Hartmann's procedure was performed. Postoperative respiratory management was needed for eight days and absorption of endotoxin was performed for 24 hours. Continuous hemodialysis filtration was performed for ten days and periodic hemodialysis was restarted on the twelfth day after operation. On the 24th day, the patient vomited blood due to bleeding from a circumferential esophageal ulcer 20 cm long. The ulcer was cured with a 15-day fast. On the 20th, 35th, and 61st day, the recurrent intraabdominal abscess was punctured using ultrasonography, and the drain was kept inserted for ten days each time. He contracted bronchitis on the 92nd day but recovered following treatment with antibiotics. The patient moved into another hospital on the 107th day to remake his vascular access. It is important to perform an operation as soon as possible and to persevere in treatment against complications even if the patient is under hemodialysis.
