Abstract
Since 1978, 3 cases of spontaneous intestinal necrosis in hemodialysis patients have been treated in our hospital. The patients showed several common peculiarities. The patients, who had a history of hypotension and abdominal discomfort probably caused by mass removal of fluid during hemodialysis, showed sudden onset of acute abdominal pain without bloody stool soon after dialysis. Laparotomy revealed fecal peritonitis due to perforation of the intestinal wall, which showed segmental necrosis. The necrosis was localized at the right side of the colon or the terminal ileum, although ischemic colitis is generally recognized on the left side of the colon. In spite of the absence of obvious vascular occlusion in the mesenterium, histological study of the resected intestine showed segmental necrosis with perforation and extensive submucosal congestion and fresh venous thrombosis in the area of the border of necrosis. Within a month after surgery, two patients died of intestinal perforation recurring on the oral side.
Insufficient blood flow in the intestinal vessels caused by hypotension and high blood viscosity are suspected to be common causative factors in this disease. Correction of the hypotension and anticoagulative treatment are suggested in the management of such cases.
