Abstract
A 77-year-old female visited the emergency room with the chief complaint of vomiting. Despite conservative medical treatment under a diagnosis of ileus, septic shock occurred during the course, forcing emergency surgery to be conducted under the diagnosis of bowel necrosis associated with obstructive colitis. Laparotomy findings showed strictures in the sigmoid colon caused by diverticulitis, and because the oral side colon was significantly extended, causing wide-ranging ischemic necrosis, subtotal excision of the colon and ileostomy were conducted. Her general condition improved following the surgery, but delayed deterioration of consciousness and flaccid paralysis in all four limbs developed. CT/MRI and an examination of the cerebrospinal fluid found no abnormalities. Based on the clinical course and electrophysiological studies, critical illness polyneuropathy associated with severe sepsis was diagnosed. Although proactive rehabilitation led to a status making it possible for the patient to live in a wheelchair, paralysis of the oropharyngeal muscles remained for a long period of time. At present, no Japanese surgeons have sufficient knowledge regarding CIP as a neurologic complication associated with severe sepsis. Consequently, this case is reported here with some bibliographical considerations.
