Abstract
Case 1 was a female in her 70's with 5-year hemodialysis history who visited the Department of Cardiology in our hospital for evaluation of coronary artery calcification and a thoracic aortic aneurysm. She underwent a computed tomography (CT) scan because free air was discovered on chest X-ray imaging. A CT scan revealed diverticulosis of the sigmoid colon and free air. We performed emergency surgery under the diagnosis of sigmoid colon diverticulosis with perforation. Diverticulosis with associated pus was observed in the sigmoid colon, and we performed Hartmann's operation. The patient was discharged on postoperative day 30. Case 2 was a male in his 70's with a 9-year hemodialysis history who visited the Department of Cardiovascular Surgery in our hospital for the purpose of a periodic inspection after coronary artery bypass graft surgery. The patient complained of low grade fever and general fatigue at that time and was admitted to the Department. A CT scan revealed diverticula of the sigmoid colon, which had collapsed, and fluid mixed with air in the pouch of Douglas. We performed emergency surgery under the diagnosis of sigmoid colon diverticulosis with perforation. Intraoperatively a perforated diverticulum was observed in the sigmoid colon, and we performed Hartmann's operation. The patient was discharged on day 104, although he needed continuous hemodiafiltration, direct hemoperfusion with polymyxin B immobilized fiber and long-term respirator management. These two abdominal findings were is very mild, so that, based on them, we did not diagnose gastrointestinal perforation at first. It is considered that chronic dialysis patients, particularly the elderly, might lack clinical manifestations such as abdominal pain, and therefore careful attention is necessary.
