Abstract
A 69-year-old woman visited a hospital because of abdominal pain was brought into our hospital by ambulance on the next day due to a worsening of symptoms. When she was seen at our hospital, the abdomen remarkably distended and there was tenderness. Abdominal contrast-enhanced CT scan revealed fecal impaction from the descending colon to the rectum. The patient went into shock and showed metabolic acidosis. Intestinal necrosis was likely and an emergency operation was performed. During surgery, mucosal necrosis of the dilated intestines was seen by a fluoroscopic study. We performed subtotal colectomy and created ileostomy and signmoid mucous fistula with a suspicion of extensive necrosis. On the eighth postoperative day intestinal juice was found to be drained and re-operation was done. Multiple perforations were present in the intestine from 10 cm to 70 cm proximal to the ileostomy. The affected intestines were resected and ileostomy was created again. Her general condition became stable after the last operation and she was discharged from the hospital on the 109th postoperative day.
In the treatment of obstructive colitis, possible postoperative occurrence of necrosis of the residual intestines as well as large bowel necrosis must always be kept in mind. In an instance in which unstable circulatory dynamics persists, we should not hesitate to perform re-laparotomy if some signs of intestinal necrosis are demonstrated.
