Abstract
An 80-year-old woman visited a neighbor clinic with left lower abdominal pain as a chief complain. White blood cell count was increased. Abdominal pain CT revealed increased density of the adipose tissue around the splenic flexure. And she was carried to our hospital with a suspect of intestinal necrosis. Abdominal contrast CT made on arrival at our hospital revealed that contrast enhancement effects were not good on the ascending to descending colon. Emergency operation was performed with a diagnosis of colonic necrosis. At laparotomy, viscous ascites and some ischemic change of serosa from the cecum to sigmoid colon were found. Based on this, we made a diagnosis of total colonic necrosis by total colonic type ischemic colitis. Pulsation of superior/inferior mesenteric arteries was palpable, indicating absence of occlusion. Total colon from the end of ileum to rectosigmoid colon was resected and ileostomy was carried out. After the surgery, the patient was transferred to ICU and followed-up under hemodialysis. On the postoperative day-42, she was discharged after withdrawal from hemodialysis. Although it is rare in ischemic colitis, colonic necrosis might spread over the entire colon. So we should carefully make a diagnosis and treat patients in consideration of such possibility.
