A Case of Necrotizing Ischemic Colitis with Colon Cast due to Lower Abdominal Trauma with Pelvic Fracture

Yoshihiro Moriwaki, Koji Kanaya, Takayuki Kosuge, Toshiro Yamamoto and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

We report a case of necrotizing ischemic colitis of the rectum with colon cast due to traumatic hypoperfusion of the pelvis. A 66-year-old man, who run was over by a truck and admitted, showed no sign of rectal or intestinal injury immediately after the accident, but we found spontaneous passage of a 160 cm colon cast on hospital day 25. Colonofiberscopy showed necrosis and perforation of the rectosigmoid colon, necessitating emergency operation on hospital day 30. Pelvic abscess was completely demarcated. The patient underwent transverse loop colostomy. Patients with severe pelvic fracture are usually treated at the department of orthopedics or intensive care. If such patients showed ischemic complications of the left side colon, the gastroenterologist, gastroenterological endoscopist, and gastroenterological surgeon must be specifically knowledgeable about gastrointestinal complications under unusual conditions, such as pelvic traumatic injury. As gastroenterology specialists we must recognize such special pathophysiology as a matter of course.

Key words
necrotizing ischemic colitis, colon cast, severe pelvic fracture

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
May 25, 2004

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