A Case of Gangrenous Ischemic Colitis Expanding to Involve the Total Colon

Abstract

This report presents a case of necrotic ischemic colitis which spread to involve the total colon from which the patient was able to survive following surgical treatment. An 81-year-old male was admitted to the hospital because of severe abdominal pain. Abdominal CT scan showed a dilated colon filled with a lot of feces, so he was diagnosed as having constipation. CT on the next morning showed a dilated colon filled with fluid. Sigmoid colon fiberoscopy revealed ischemic changes of the sigmoid colon. The abdominal pain worsened, the abdominal muscular defense became harder and the patient went into shock, so an emergency operation was performed. Laparotomy revealed massive bloody ascites and the large intestine was necrotic from the cecum to the sigmoid colon, so a total colectomy was conducted. The gangrenous area was found to have migrated from the cecum to the terminal ileum during surgery, which mandated an additional excision of the terminal ileum and construction of an ileostomy. The patient was finally diagnosed as having necrotic ischemic colitis based on the histological findings.