Abstract
With the recent aging society, the number of operations for oldest-old patients more than 90 years old has been increasing. We report a case of panperitonits in an oldest-old patient who was saved by emergency operation.
The case involved a 99-year-old woman whose preoperative performance status was 1. In August 2011, she was brought into our hospital by ambulance because of the abrupt onset of abdominal pain. There was tenderness in the entire abdomen, but inflammatory reaction was negative on blood biochemical findings. Abdominal CT scan revealed a mass of stool and free air which had escaped from the sigmoid colon to the abdominal cavity. Hartmann operation was performed with a diagnosis of perforation of the sigmoid colon. We identified stool juice and a perforated site of the sigmoid colon in the abdominal cavity. Endotoxin absorption therapy was made after the operation and respiration was managed by mechanical ventilation Extubation became possible on the fifth postoperative day. Except delirium, no postoperative complications occurred and the patient was discharged from our hospital on the 47th postoperative day.
As peritonitis affecting the aged people lacks characteristic findings, sometimes we have difficulties in diagnosis. However, in this case, diagnosis and treatment in an early time after the onset of the disease might result in lifesaving for the patient.
