Abstract
A 62-year-old man treated for liver cirrhosis, and admitted for severe a abdominal pain with fever on Feb 25, 2001, was found in physical abdominal examination to have muscle guarding and rebound tenderness. Abdominal computed tomography (CT) showed prominent thickening of the wall from the cecum to the ascending colon, suggesting intestinal edema. Emergency laparotomy showed purulent ascites throughout the abdominal cavity and confirmed a dark-colored ascending colon with edema, necessitating right hemicolectomy with ileostomy, abdominal irrigation, and drainage. The patient developed septic shock an hour after surgery and was treated by immediate blood perfusion by polymyxin B immobilized column (PMX). His low blood pressure improved, and he was administered gamma-globulin and antibiotics. Bacterial culture of arterial blood and ascites showed E. coli. Histopathologically, the resected specimen was diagnosed as phlegmonous enterocolitis. The patient was discharged 3 months postoperatively. It is considered that even seriously ill patients of phlegmonous enterocolitis can be rescued by bowel resection and intensive care.
