A Case of Strangulated Obstruction Resulting From Looping of an Ileal Segment Around the Elevated Colon of at the Site of Colostomy

Abstract

A 63-year-old man who had undergone surgery with colostomy for volvulus of the sigmoid colon was referred to our hospital complaining of acute abdominal pain. At presentation, visual inspection revealed ischemic change of the mucosal layer of the artificial anus and abdominal computed tomography showed abnormally dilated intestinal loops, and ascites. Emergency surgery was performed under the diagnosis of strangulation ileus associated with the artificial anus. Laparotomy revealed a gap between the elevated large bowel of the artificial anus and the abdominal wall. An adjacent loop of the small intestine was incarcerated through the gap. The incarcerated portion of the intestine exhibited ischemic change, and we resected the ischemic intestinal segment. The small intestine became strangulated when it got wound on to the elevated intestinal tract through the large gap between the elevated large bowel and the abdominal wall. When an intraperitoneal course is chosen for colon construction with an artificial anus, care should be taken to avoid leaving a gap, in consideration of the possibility of occurrence of this rare type of strangulation ileus.