2003 Volume 23 Issue 5 Pages 799-803
An 82-year-old male seen for lower abdominal pain was found to have no abdominal free air in abdominal plain radiography and abdominal computed tomography (CT). No definitive preoperative diagnosis was possible but his condition was within the definition of systemic inflammatory response syndrome (SIRS) and his physical findings suggested panperitonitis. In laparotomy, we found the sigmoid colon necrotic for 18cm and a hole in the bowel wall. Supply artery pulsation was good, eliminating embolism of the inferior mesenteric artery as a cause. We resected the necrotic colon and made a stoma with the descending colon. After surgery, he gradually recovered and oral intake was started on postoperative day (POD) 12. On POD 14, however, his general condition suddenly worsened and he died within 2 hours. We suspect that the cause of death complication by pulmonary infarction. Transient and strictive ischemic colitis are generally treated conservatively and the prognosis is good. The gangrenous type, although it is less frequent, progresses immediately to panperitonitis so its prognosis is poor and emergency surgery is needed. In nonperforative cases, in particular, preoperative diagnosis is very difficult. Two important factors in prompt diagnosis of this condition are the recognition of SIRS and physical findings. The complication of postoperative pulmonary infarction should thus be taken into consideration.
