宿便性大腸穿孔の１例―エンドトキシン吸着療法の効果―

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  • A Case of Stercoral Colon Perforation-Effect of Polymyxin B Direct Hemoperfusion Treatment-

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A 74-year old female was admitted to our hospital because of a lower abdominal pain and vomiting. Acutepanperitonitis caused by a gastrointestinal perforation was suspected because of muscular defense throughout her entireabdomen and diffuse pneumoperitoneum findings during a computed tomography examination. An emergency laparotomywas performed based on a preoperative diagnosis of colon perforation, since the patient's laboratory resultsrevealed leukopenia at the time of admission. During the operation, a thumb-sized round perforation with sharp edgeswas found in the sigmoid colon, and several hard stools were scattered in the peritoneal cavity close to the perforationsite. Moreover, the proximal side of the perforation was packed with a large amount of hard stools up to the ascendingcolon. Based on these clinical findings, a diagnosis of stercoral colon perforation was made and a sigmoidectomy withcolostomy was performed. Because the leukopenia persisted after the operation, the patient underwent a polymyxin Bdirect hemoperfusion (PMX-DHP) treatment on the same day. The patient's leukopenia improved on the followingday, and her postoperative course was favorable without any complications, such as respiratory failure or surgical siteinfection. She was discharged from hospital on postoperative day 29. PMX-DHP treatment might be useful forpromoting a favorable postoperative course in patients with colon perforations and preoperative leukopenia.

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