広範な腸管壊死を来した虚血性腸炎の３例

Abstract

We saved 3 patients from gangrenous ischemic enteritis. Patient 1; a 57-year-old woman in shock 24 hours after her first admission was found in an emergency laparotomy to have intestinal necrosis from the ileum to the descending colon, necessitating subtotal ileocolectomy. Three days later, intraoperative endoscopy in a second-look operation showed that the necrotic area extended to the small intestine, and a resection of the necrotic intestine and a ileosigmoidstomy were done. Patient 2; a 78-year-old man found with necrosis of the rectal mucosa during colonoscopy, underwent emergency laparotomy showing transmural necrosis from the descending colon to the upper rectum. The necrotic colon was resected and a tube colostomy was established in the cecum. Five days later, intraoperative endoscopy showed partial mucosal necrosis of the ileum end, and a stoma was formed in the cecum preserving the Bauhin valve. Patient 3; a 72-year-old woman who developed shock and diagnosed with gangrenous ischemic colitis based on computed tomography had serosa of the entire colon normal in color, but mucosal necrosis of the colon was identified by intraoperative colonoscopy. The necrotic colon was resected and a stoma formed in the ascending colon. All 3 patients survived with a fair quality of life, including diarrhea control. Total resection of an intestine with mucosal necrosis is for short-term life but may ruin the quality of life due to short bowel syndrome. Necrosis of the intestine may progress after the first operation. Careful therapic strategy including secondlook operation is required for patients with gangrenous ischemic enteritis. Intraoperative endoscopy is helpful for evaluating the resection.