A Case of Necrotic Ischemic Colitis Expanded to Total Colon

Masahiko Kawaguchi, Shigeichi Fujioka, Rinichirou Wakasa and Shuichi Murata

Department of Surgery and Gastroenterology, Himi Municipai Hospital

Necrotic ischemic colitis spreading to the total colon is a rare, severe condition that can cause peritonitis via large intestinal perforation. A previously healthy 51-year-old woman admitted for epigastralgia. It was found in abdominal computed tomography (CT) to have a loss of haustration in the transverse colon. Bowel sounds were detected. She was initially diagnosed with enterocolitis. A few hours later, her abdominal pain worsened and the abdomen exhibited muscular defense. Five hours after admission, CT showed ascites and paralytic ileus. At laparotomy, massive bloody ascites was observed and the large intestine from cecum to splenic flexure was necrotic. Neither anatomical abnormalities in the mesentery vascular course nor blocked arteries were seen.
The gangrenous area of the colon migrated from the descending colon to the sigmoid colon during surgery. We conducted a subtotal colectomy and an ileostomy. Biological testing showed no infectious organism in ascites or feces. Histology showed a full thickness necrosis in the colon and massive congestion in the submucosal layer. This is lethal and the severest type of ischemic colitis, which may progress to the whole colon. Only immediate surgery can halt this.

Key words
necrotic ischemic colitis, total colectomy, pan peritonitis

Reprint requests
Masahiko Kawaguchi Department of Surgery, Yokohama Sakae Kyousai Hospital 134 Katsura-cho, Sakae-ku, Yokohama-city, 247-8581 JAPAN

Accepted
September 25, 2002

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