Abstract
The patient was a 78-year-old female with a history of undergoing appendectomy. After having lunch, she experienced severe lower abdominal pain and presented to our emergency outpatient clinic. Abdominal contrast-enhanced CT scan revealed a closed loop of the small intestine and increased fat concentration in the mesentery. The patient was diagnosed as having strangulated ileus and underwent emergency surgery. Hemorrhagic ascites accumulated inside of the abdominal cavity. Removal of a strangulated funicular substance revealed good beating of peripheral arteries and the presence of intestinal peristalsis in spite of color tone failure of the intestinal wall. Bowel resection was not conducted. Although the clinical course was good, fever with shivering developed on the 6th and 9th days after the surgery when the patient started eating. Blood culture showed Bacillus cereus colonies on both occasions. Since there were no abdominal symptoms or infectious sources, bacterial translocation (BT) was suspected and meropenem administration was initiated. There was no fever incidence after that, and the patient resumed eating. She was discharged 22 days after the surgery. Care should be taken for development of BT in addition to perforation and stricture in the case of mucosal membrane damage due to ischemic enteritis following release of strangulated ileus.
