An 87-year-old man with hypertension, osteoarthritis, and dementia was admitted to the authors' hospital with severe lower abdominal pain. The initial vital signs were as follows: blood pressure 160/97 mmHg, pulse rate, 92 beats per minute; and body temperature, 36.8℃. Physical examination revealed diffuse abdominal tenderness and rebound tenderness, particularly in the lower abdomen. Laboratory examination revealed a white blood cell count of 860 cells/mm
3 suggesting leukocytopenia, a c-reactive protein of 0.65 mg/dL and a lactate level of 17.7 mg/dL. Two years ago, the patient underwent the Hartmann operation and reversal for a distal sigmoid colon perforation due to ischemic colitis. One year later, he underwent a second Hartmann operation for recurrent sigmoid colon perforation at another hospital. Abdominopelvic computed tomography on the third admission revealed a sigmoid colon perforation proximal to the previously built colostomy (
Fig. 2). In the operative field, a 3 cm colon perforation was observed proximal to the colostomy, and colonic ischemia with fecal soiling was observed throughout the abdominal cavity. Segmental colon resection, including the perforation site and end transverse colostomy formation, was performed. The patient was discharged on the 17th postoperative day. During the 1-year follow-up period, the patient showed no recurrence of ischemic colitis.
![emj-46-3-7-g2](/upload/SynapseXML/0201emj/thumb/emj-46-3-7-g2.jpg) | Fig. 2.The perforated colon wall was not enhanced in abdomino-pelvic contrast tomography, suggestive of ischemic colitis (red arrow).![Download Figure Download Figure](/image/icon/down_figure.gif)
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