A Case of Gangrenous Ischemic Colitis Resulting from Heat Stroke

Abstract

A 68-year-old man on oral antihypertensive therapy was brought to our hospital as an emergency on a very hot day in July after developing excessive sweating, inability to stand, hypotension, and bradycardia after having been working outdoors. His vital signs on arrival were indicative of shock, with a Japan Coma Scale score of I-3, heart rate of 42 bpm, blood pressure of 72/44 mmHg, and SpO₂ that was not measurable. Heatstroke was diagnosed on the basis of his medical history and physical signs, and when lactated Ringer's solution was administered, his vital signs rapidly stabilized, and his symptoms started to improve. Blood tests showed moderate renal impairment (BUN 36.0 mg/dL, creatinine 2.32 mg/dL), and abdominal computed tomography (CT) showed gas in the hepatic portal vein. On the basis of these findings, Grade III heatstroke and hepatic portal venous gas were diagnosed, and the patient was admitted. Although his renal function improved the following day, abdominal pain intensified, and another CT scan showed localized intestinal pneumatosis in the left transverse colon, hyperdensity of the surrounding adipose tissue, and accumulation of ascites. Intestinal necrosis was diagnosed, and partial transverse colectomy was performed the same day. It is comparatively rare for gangrenous ischemic colitis, requiring colectomy to develop as a result of heat stroke, and the present case is reported along with a short discussion of the literature.