Abstract
We had great deal of difficulty in treatment of obstructive colitis and enteritis due to fecal ileus detected at an emergency operation for peritonitis in a 51-year-old woman without previous history of undergoing a laparotomy.
The patient was seen at the hospital because of pain in the entire abdomen. She had been suffered from constipation lasting for one week. There were signs of generalized peritonitis. Upon laparotomy, fecal ileus was disclosed and the necrosed sigmoid colon due to fecal mass was confirmed. An open colostomy was made at the descending colon. Prolonged symptoms of peritonitis after the operation demanded another laparotomy, when necrosed portions were found in the descending colon and ileum. Obstructive colitis with obstructive enteritis was diagnosed. After the necrosed intestines were resected, a transverse colostomy and an ileostomy were made. The patient recovered with postoperative therapies with CHDF and PMX, and, about 10 months later, underwent closures of the ileostomy and transverse colostomy.
Etiologically obstructive colitis is caused by cancer in most cases, and it is very rare that fecal ileus causes the disease. This case of obstructive colitis caused by fecal ileus is thought significant from standpoint of its association of obstructive enteritis which is also very rare. We have difficulty in making the correct intraoperative diagnosis of obstructive colitis and enteritis, and should strictly follow the postoperative clinical course.
