A CASE OF NECROTIZING ISCHEMIC COLITIS OCCURRED IN A PATIENT ON HEMODIALYSIS

Abstract

A 71-year-old woman on hemodialysis for 18 years underwent a laparotomy with a diagnosis of peritonitis at the hospital, when localizing necrosis was detected in the cecum and ascending colon. A right hemicolectomy was performed and reconstructed with end-to-end anastomosis between the small intestine and transverse colon where revealed macroscopically favolable blood flow. But the patient developed hypotension during hemodialysis on the 4th day after the operation, and then an abdomonal pain on the next day. Laparotomy was conducted again with a diagnosis of anastomotic breakdown, and a colostomy of the transverse colon was carried out. Histopathologically, no arterial obstruction was noted in the resected colon, and the diagnosis of necrotizing ischemic colitis due to non-occlusive mesenteric ischemia (NOMI) was made. It was thought that genesis of suture failure might result from a decrease in the mesenteric perfusion due to hypotension during hemodialysis.
There have been 57 reported cases of ischemic colitis in hemodialysis patients in these 15 years. Their average duration of hemodialysis was 8.2 years and 58.7% of these lesions were in the right side of the colon. Most patients complained of only abdominal pain and were not associated with anal bleeding. It is desirable that resection of the necrotized colon should be followed by colostomy and then anastomosis on a two-step approach. As perioperative management, caution should be employed to possible occurrence of hypotension during hemodialysis.