A Case of "Takotsubo" Cardiomyopathy with Ventricular Tachycardia after Surgery for Rectal Perforation

Terumitsu Sawai, Masatoshi Haseba, Hideki Yamashita, Hiroaki Takeshita, Shigekazu Hidaka, Takashi Tsuji, Atsushi Nanashima, Hiroyuki Yamaguchi, Toru Yasutake, Tohru Nakagoe and Takeshi Nagayasu

Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences

A 71-year-old woman taking 10 mg/day of predonisolone for rapidly progressive glomerulonephritis was admitted for severe abdominal pain. Temperature was 38.8°C and she had a muscular rigidity with tenderness in the lower abdomen. Abdominal X-ray and CT showed intraperitoneal free air and a large amount of feces in the rectouterine pouch. Under a diagnosis of rectal perforation, we partially resected the rectum and constructed a terminal colostomy. The patient was returned to the intensive care unit and treated on an artificial respirator with continuous hemodiafiltration. The postoperative course was satisfactory until postoperative day (POD) 7. Eight days after surgery, she suddenly reported general fatigue and ventricular tachycardia occurred in electrocardiography. The ST segment was elevated in leads II, III, aV_F, and V₂-V₆. Ultrasound cardiography showed asynergy of apical akinesis and basal hyperkinesis with a significant pressure gradient of 60∼130 mmHg. She was diagnosed with "takotsubo" cardiomyopathy. The left ventricular function improved to almost normal within the next 3 weeks. This possibility showed thus be kept as a potential complication after gastrointestinal surgery.

Key words
"takotsubo" cardiomyopathy, ventricular tachycardia, rectal perforation

Reprint requests
Terumitsu Sawai Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
July 23, 2003

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