A 70’s-year-old man was admitted to our hospital, because of a transient loss of consciousness. At the time of admission, his level of consciousness was almost alert. His abdomen was extremely distended without signs of abdominal pain or peritoneal irritation. An abdominal computed tomography scan demonstrated ascites and dilation of the entire colon with massive amounts of feces in the rectum and sigmoid colon. An arterial blood gas assay revealed severe metabolic acidosis. We suspected colonic necrosis; thus, an emergency laparotomy was performed. We performed decompression by opening the sigmoid colon and removing feces. An intraoperative finding revealed an ischemic change at the descending colon. We then performed a left hemicolectomy and colostomy. The stoma became necrotic 2 days after the colostomy. An endoscopic examination showed no ischemic change in the mucosa at the intraabdominal colon. Additional resection was not required. The patient was transferred to a different hospital 45 days later. Obstructive colitis due to fecal impaction can require an emergency laparotomy for decompression, resection of a necrotic lesion, and treatment of the appearance and extent of necrosis.
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