AN OPERATED CASE OF CANCER OF THE SIGMOID COLON WITH PERIFORATION CAUSING A WIDE RANGE OF INTESTINAL ISCHEMIA

Abstract

A 68-year-old woman was admitted to another hospital because of abdominal pain. A drop in blood pressure occurred on the next day and the patients was transferred to the hospital with a diagnosis of intestinal obstruction. On admission the face showed her agony, there was abdominal distention, and she was in a state of shock. Simple abdominal X-ray examination on lateral recumbent position revealed intraperitoneal free gas. The patient was diagnosed as having perforation of the lower digestive tract and underwent an emergency operation. Large amount of scyballum and liquid feces had accumulated in the abdominal cavity. There were a stenosis due to a cancer of the sigmoid colon and a perforation 5cm in diameter 3cm oral side from the stenosis, and a portion of the intestine from that region to about 50cm anal side of Treitz' ligament was segmentally marked by a dark brown color, indicating impaired circulation. The ischemic portion of the intestine including the carcinoma and perforacted site was excised and a jejunostomy was performed. Postoperative septicemia and disseminated intravenous congestion occurred, but the patient recovered. Total parenteral nutrition is being conducted at home to treat short bowel syndrome. Such cases of simultaneous occurrence of occlusive colitis associated with perforation fo the large intestine and non-occlusive mesenteric infarction (NOMI) are very rare, and this case is here described together with a review of the literature.