A Case of the Gangrene Type of Ischemic Colitis After Abdominoperineal Excision of Rectum

Naomi Kawata, Shingo Saito, Yoshikazu Suzuki, Takashi Funatsu*, Nobuaki Kobayashi**

Department of Surgery and Internal Medicine*, Tsushima Municipal Hospital
First Department of Surgery, Ehime University School of Medicine**

As the gangrene type of ischemic colitis is often fatal, we should pay attention to the disease. Recently we experienced a patient with the disease who had received abdominoperineal excision of rectum (Mile's operation) 30 years earlier, and associated liver cirrhosis. A 78-year-old woman complained of sudden left lateral abdominal pain and watery diarrhea after constipation for 3 days. Soon she went into shock and was admitted to our hospital. Muscular rigidity, tenderness and Blumberg's sign were recognized over her entire abdomen. We performed an emergency operation under the diagnosis of "acute panperitonitis" 5 hours after onset. There was no perforation in the gastro-intestinal tract. The splenic flexus of the colon was necrotic for a length of 25 cm but the mesenteric vessels were intact. We diagnosed the condition as ischemic colitis, gangrene type, and resected the necrotic segment. The oral stump was used for a colostomy and the anal stump was closed. She recovered under strict post-operative care with a respirator and the like. The cause of this disease is not yet clear. In this case, ischemia of the colon produced by Miles's operation, congestion and coagulation disturbance caused by liver cirrhosis may have played important parts in causing the disease. Early laparotomy is the only life-saving therapy. We consider that resection of the injured segment and colostomy is a reasonable operative procedure.

Key words
gangrene type of ischemic colitis, acute abdomen, liver cirrhosis

Reprint requests
Naomi Kawata Department of Surgery, Tsushima Municipal Hospital
Takata, Tsushima-cho, Kitauwa-gun, Ehime, 798-33 JAPAN

Accepted
May 13, 1992

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