Abstract
We report a patient who suddenly developed pulmonary embolism, respiratory arrest and circulatory collapse because of megacolon. A 67-year-old woman who had abdominal bloating six months before, and had general fatigue from one week before admission, suddenly became respiratory arrest and circulatory collapse on the way to doctor visit. She was transported to our hospital after return of spontaneous circulation in response to the resuscitative maneuver. Although consciousness was recovered on arrival at hospital, significant abdominal bloating and lower-limb edema was observed. Chest X-rays showed that patient's heart was extremely pressed to the right side of thorax by a enlarged colon filled with gas. Blood clots were recognized at bilateral lower pulmonary artery by thorax and the abdominal enhanced CT. Gut distention was relieved by colon fiberscopy. We started thrombolytic treatment. The pulmonary artery thrombus was diminished on the 4th day and she was discharged from hospital on the 19th day. She underwent elective total colectomy and made unevenful recovery. More than 90% of the thrombi that induce pulmonary embolism are produced in pelvic vein. In this case, we considered that dehydration and increased intra-abdominal pressure because of megacolon caused venous stagnation, which developed pulmonary embolism.
