A 68 year-old woman presented
with lower abdominal pain for three days and constipation for 10 days. The
patient had a history of end-stage renal disease under regular hemodialysis,
and coronary artery disease with antiplatelet drug. Physical examination was
unremarkable except rebounding tenderness over lower abdomen. Blood tests
showed bandemia 9% in white blood cell counts and elevated C-reactive protein
(>250 mg/L, reference value, <3 mg/L).
Abdominal radiography showed sign of
retroperitoneal air - the presence of air outlining the psoas muscle (Figure 1,
arrow) and one gas-contenting abscess at left lower quadrant abdomen. Computed
tomography (CT) of the abdomen
revealed a large amount of fecaloma within sigmoid colon with wall
thickening and pericolic fat stranding, and extravasation of stool material at
left pelvic region (Figure 2, arrow), and pneumoretroperitoneum extending from
the lower abdominal abscess.
Under the impression of stercoral
colitis associated sigmoid colon perforation, emergent exploratory laparotomy
was performed. One 1.6*1 cm perforation of sigmoid colon with abscess formation
was found. The pathologic report of colon resection specimen shows aggregates
of hemosiderin-laden macrophages in colonic mucosa with focal transmural
necrosis. The post-operation course was smooth, and the patient was discharge
uneventfully twelve days later.
No comments:
Post a Comment