A Case of Obstructive Colitis with Extensive Small Bowel Necrosis

Yoshikazu Fukuda, Kazuma Tsukioka, Fumihiro Kawasaki, Yoshio Matsuo, Takahisa Yoshimura, Osamu Yamazaki*, Hiroshi Otani*

Osaka City General Hospital, Emergency, and Critical Care Medical Caneter
Department of Digestive Surgery*

A 51-year-old woman with acute abdominal distension was transferred to our medical center because of shock 6 hours after the onset of the disease. Her abdomen was extremely distended and digital examination revealed massive clayey feces. As computed tomography revealed gas in the mesenteric veins, an emergency laparotomy was performed. The bowel from the sigmoid colon to the jejunum of the distal 280 cm over the terminal ileum was totally necrotized. A normal segment 15 cm in length was detected between the necrotized bowel and the fecal mass of the rectum. All the major mesenteric vessels were pulsating normally at the operation. After the entire necrotized bowel was resected, jejunostomy and sigmoid colostomy were performed. The patient started per os 20 days postoperatively. So far as we could find in the literature, only two cases of severe necrotizing obstructive colitis extending to the ileum have been reported. Therefore our case might be the first one with extension to the jejunum. In our case, the bowel had been in the chronic ischemic state due to the diabetic microvascular lesion. In addition to the condition, the massive bacterial reflux into the jejunum from the colon caused the capillary vasoconstriction of the bowel and that made her so critical.

Key words
severe type obstructive colitis, jejunal necrosis, fecal impaction

Reprint requests
Yoshikazu Fukuda Osaka City General Hospital, Emergency and Critical Care Medical Center
2-13-22 Miyakojima-hondouri, Miyakojima-ku, Osaka, 534 JAPAN

Accepted
November 15, 1995

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