Ｓ状結腸捻転術後，急激な経過をたどった悪性症候群の１例

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  • A Case of Neuroleptic Malignant Syndrome (NMS) after Operation for of Sigmoid Volvulus

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We report a case of neuroleptic malignant syndrome (NMS) after an operation for sigmoid volvulus. A 54-year-old man who had a history of schizophrenia since the age of 18, complained of vomiting and abdominal pain, and was admitted to the hospital for acute peritonitis. Abdominal X-ray examination and abdominal CT revealed a markedly dilated sigmoid colon. General peritonitis was suspected and an emergency laparotomy was performed, which showed volvulus of the sigmoid colon with a 180°C clockwise torsion. Five days after the operation, a high grade fever (over 40°C) persisted despite administration of antibiotics and normalization of white blood cell count. The patient demonstrated extrapyramidal symptoms, and NMS was diagnosed. Although much infusion and systemic cooling was performed, the patient died suddenly five days after the operation. The autopsy showed no significant pathological changes of any tissues, (including brain, muscle, and heart.). NMS must be kept in mind as a differential diagnosis of treatment-resistant patients with high grade fever, if the any antipsychotic agents have been administered to the patient.

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