広範な粘膜剥離を伴って完全な腸管閉塞を来した重症虚血性大腸炎の1例

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  • A CASE OF SEVERE ISCHEMIC COLITIS DEVELOPING, COMPLETE INTESTINAL OBSTRUCTION AFTER CONSERVATIVE TREATMENT

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A 44-years old man was admitted to the DM (Diabetes Mellitis) center of our hospital because of diabetic ketoacidotic coma. On the second day of admission he complained of bloody stools and left lower abdominal pain. He defecated a material like necrotic intestinal mucosa on the 21st day and was referred to our department. Ischemic colitis was suspected on barium enema and endoscopy because of the existan-ce of an irregular ulcer and a stenosis on the oral side of the sigmoid colon. The patient was treated with conservative measures including total parenteral nutrition and colostomy. The irregular-shaped ulcer was healed, however, the stenosis was deteriorated to intestinal obstruction. Thereafter, colectomy was performed on the 159th day from the onset. The intestinal lumen was not found, but an obstruction, 2cm in length, existed on the specimen. There was a scar of ulcer (mostly Ul-II, partly Ul-II) with prominent hemosiderin deposit. Finally it was diagnosed as ischemic colitis. We speculated that defecation of a material like necrotic intestinal mucosa, progres-sive stenosis and complete intestinal obstruction can occur in the case of severe ischemic colitis although they are very rare symptoms.

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