A Successfully Treated Case of an Ischemic Colonic Necrosis with Septic Shock in a Patient of Very-advanced Age (102-Year-Old)

Takami Fukui¹⁾, Naoki Yokoo¹⁾, Takahiro Yoshida¹⁾, Chihiro Tanaka¹⁾, Hisaya Azuma¹⁾, Takashi Shiroko¹⁾, Yasuhito Kitakado¹⁾, Kiyohisa Okamoto²⁾, Tatsushi Kato³⁾ and Tetsuya Yamaguchi⁴⁾

Department of Surgery¹⁾ and Department of Pathology²⁾, Takayama Red Cross Hospital Department of Gastroenterological Surgery, Kyoto University School of Medicine³⁾
Department of Surgery, Rakuwakai Otowa Hospital⁴⁾

We treated successfully a case of ischemic colonic necrosis with septic shock in a patient of very-advanced age by a massive colectomy. A 102-year-old woman was admitted to our hospital because of vomiting and abdominal pain. On admission, she was critically ill, presenting symptoms of septic shock. Under the diagnosis of strangulated ileus, an emergency laparotomy was carried out. On laparotomy, a massive necrosis of the colon between the hepatic flexure and the distal end of the descending colon was revealed, and, was histologically proven to be caused by ischemic colonic necrosis. Since the patient had many risk factors, including dehydration, septic shick, advanced age, and a highly invasive operation, her hemodynamic and respiratory condition after the operation was quite unstable. Therefore, a close watch on these states was kept for 7 days after the operation, using an S-G catheter. During postoperative treatments, attention was focussed on main taining a hyperdynamic state based on accurate hemodynamic and respiratory parameters. Owing to these meticulous postoperative treatments, a successful outcome was achieved.

Key words
a patient of super-advanced age, septic shock, emergency operation

Reprint requests
Takami Fukui Department of Surgery, Takayama Red Cross Hospital 3-11, Tenman-cho, Takayama City, 506-8550 JAPAN

Accepted
October 31, 2000

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