Abstract
A 79-year-old woman was referred to our hospital by her previous doctor because of abdominal pain and melena. Based on abdominal CT scan and colonoscopy conducted on admission, the patient was diagnosed with having intestinal perforation caused by ischemic colitis, but was initially given conservative treatment. However, due to an increase in the amount of free air on abdominal CT scan, the onset of ascites, and exacerbation of the inflammatory response on the hospital day 3, emergency laparotomy was performed. No apparent necrosis or perforation was observed in the intestinal tract, and intraperitoneal lavage and drainage were performed. As HTLV-1-associated myelopathy (HAM) was identified as an underlying disease, and Pseudomonas aeruginosa and Candida albicans were detected in the ascites culture, the symptoms were attributed to worsened ischemic colitis caused by decreased immunological competence. Therefore, when ischemic colitis occurs in patients with decreased immunological competence, like in the present patient, the possibility of worsening of the disease must be kept in mind.
