Acute necrotizing colitis due to sigmoid colon cancer
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Acute necrotizing colitis due to sigmoid colon cancer Hiroki Matsunaga1,2, Dai Shida3*, Makoto Kamesaki2 and Yuichi Hamabe2
Abstract When obstructive colitis becomes fulminant, it is known as ‘acute necrotizing colitis’. We report a rare case of acute necrotizing colitis due to sigmoid colon cancer, in which shock status occurred within ten hours of onset. A 79-year-old female with acute abdominal pain was transported to our hospital with acute shock. Abdominal enhanced computed tomography revealed thickening of the wall of the sigmoid colon and marked dilation of the proximal colon. Emergency surgery was performed with the intraoperative findings of severe sigmoid colon stenosis and proximal dilation of the colon without perforation, and a large volume of putrid ascitic fluid. The intestine was proximally dilated and black in color, from the sigmoid colon to the ileum 60 cm proximal to the terminal ileum, suggesting acute necrosis. Total colectomy with 80 cm resection of terminal ileum and ileostomy was performed. Whereas acute necrotizing colitis is a rare condition and its etiology remains obscure, the chronic ischemic state must play some role. Our patient was of advanced age and had diabetes mellitus and hypertension. These factors might lead to a chronic ischemic state of the bowel due to arteriosclerosis. In addition to the underlying condition, massive bacterial reflux into the ileum from the colon might cause the capillary vasoconstriction of the bowel that led to her critical state. Keywords: Necrotizing colitis, Fulminant obstructive colitis, Obstructed colon cancer
Background Obstructive colitis is a condition defined as nonspecific inflammatory lesions of the colon, such as erosion and ulceration, proximal to a completely or partially obstructive lesion [1-3]. Obstructive colitis, although rare, can become fulminant, which is then known as ‘acute necrotizing colitis’ [4,5]. Extensive colonic gangrene associated with colonic obstruction is a serious complication requiring emergency surgery. Only few cases of acute necrotizing colitis due to colon cancer are reported in the English medical literature [6-8]. We experienced a case of acute necrotizing colitis and ileitis due to colon cancer with a rapid clinical course, in which shock status occurred within ten hour of initial symptoms. The patient was saved only after intensive care and two emergency operations, thus emphasizing the importance of these interventions in such cases.
* Correspondence: [email protected] 3 Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 1040045, Japan Full list of author information is available at the end of the article
Case presentation A 79-year-old female with acute, gradually worsening abdominal pain requested emergency services. By the time of their arrival, she had collapsed. She was transported to our tertiary emergency medical center. Physical examination on admission revealed a Glasgow coma scale of E4V5M
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