A Case of Severe Acute Colonic Pseudo-obstruction after Laparoscopic Low Anterior Resection

MATSUMOTO Tomoko, YOSHIKAWA Katsuhiro, KOBAYASHI Toshinori, INADA Ryo, OISHI Masaharu, HAMADA Madoka

doi:10.3919/jjsa.77.1138

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敗血症性ショックを呈した術後急性結腸偽性閉塞症の1例
症例敗血症性ショックを呈した術後急性結腸偽性閉塞症の1例
ショウレイハイケツショウセイショックオテイシタジュツゴキュウセイケッチョウギセイヘイソクショウノ 1レイ

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Abstract

A 63-year-old male with a diagnosis of Ra, cT3, N1, M0, cStage IIIa rectal cancer underwent laparoscopic lower anterior resection. The stomach, small intestine, and colon were found to be enlarged during surgery. Although defecation and flatus were present after surgery, the large intestine was markedly enlarged from the descending to the ascending colon and the small intestine contained gas, suggesting postoperative intestinal paresis. In spite of some intestinal pressure relief through a transnasal ileus tube, complications of translocation of Pseudomonas aeruginosa from the enlarged intestine, septic shock, and disseminated intravascular coagulation (DIC) developed on the 20th postoperative day. We were able to treat the DIC by advancing the transanal ileus tube to lower the pressure in the enlarged intestine and achieve whole body control. An endoscopic examination and computed tomography revealed no evidence of inadequate suturing or an obstruction point ; there was no blood flow disorder, enteritis, or other evidence of infection ; therefore, an acute colonic pseudo-obstruction following abdominal surgery was diagnosed.<BR>Although reports on postoperative acute colonic pseudo-obstruction are not novel, this case is unusual in that the problem followed a laparoscopic procedure and was accompanied by septic shock.

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 77 (5), 1138-1144, 2016

Japan Surgical Association

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