Abstract
A 67-year-old man with abdominal pain and fever was referred to our hospital. Physical examination revealed tenderness, rebound tenderness and muscle guarding over the entire abdomen. The white blood cell count was 6,700/mm3 and the serum C-ractive protein level was 21.7 mg/dL. Further investigation by abdominal computed tomography (CT) showed wall thickening of the sigmoid colon and free air in the abdominal cavity, and multiple liver metastases The patient was diagnosed as having perforated sigmoid colon cancer, however, preoperative examination revealed that the patient also had unstable angina pectoris. Although emergency operation was needed for the perforated sigmoid colon, we first undertook percutaneous coronary intervention for the two diseased coronary arteries. Subsequently, abdominal surgery was performed; purulent ascites and severe inflammation of the sigmoid colon were noted, however, the perforation could not be identified; therefore, abdominal irrigation and drainage was performed, followed by colostomy with double orifices. The patient developed pneumonia and pulmonary edema postoperatively, but could be discharged from the hospital on the 87th postoperative day.
