Abstract
A 46-year-old male patient was admitted to our neurology department for medical treatment of sudden-onset muscle pain and numbness in the extremities. On the 5th hospital day after admission, the patient developed severe abdominal pain ; the imaging findings showed a remarkably dilatated right hemicolon, which suggested impending rupture of the ascending colon. Acute colonic pseudo-obstruction (Ogilvie syndrome) was diagnosed because no remarkable obstruction was observed in the colon. Emergency decompression surgery was performed on the same day. First, an appendectomy followed by direct aspiration from the appendix stump was performed for colon decompression ; subsequently, suture repair of the ruptured ascending colon serosa was performed. A nasal ileus tube was intraoperatively inserted for further decompression. The patient was discharged on the 24th postoperative day. Acute colonic pseudo-obstruction due to acute porphyria was suspected in this case because peripheral and autonomic nervous symptoms accompanied by an elevated urinary coproporphyrin level were observed. We considered that emergency surgical decompression without colostomy helped avoid colon rupture in this case.
