Ischemic Colitis after Closure of Temporary Ileostomy for Low Anterior Resection of Rectal Cancer in a Dialysis Patient-A Case Report

Dialysis patients are at increased risk of ischemic colitis and are likely to develop irreversible ischemic colitis. We report a rare case of ischemic colitis after the closure of a temporary ileostomy for low anterior resection(LAR)of rectal cancer in a dialysis patient. A 77-year-old man undergoin...

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Bibliographic Details
Published in:	Gan to kagaku ryoho Vol. 48; no. 2; p. 279
Main Authors:	Nakayama, Yoshihito, Mashiko, Ryutaro, Maruyama, Hiroki, Morishima, Rento, Yamazaki, Keisuke, Yamazaki, Shiho, Yoshida, Satoru, Maruyama, Shota, Nishimura, Ryuichi, Hamada, Yoh, Sato, Tomoyuki, Harata, Toru James, Hirama, Kimiaki, Mizuno, Yutaka
Format:	Journal Article
Language:	Japanese
Published:	Japan 01-02-2021
Subjects:	Aged Anastomosis, Surgical Colitis, Ischemic - etiology Colitis, Ischemic - surgery Colostomy Humans Ileostomy Male Postoperative Complications - etiology Rectal Neoplasms - surgery Renal Dialysis
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Summary:	Dialysis patients are at increased risk of ischemic colitis and are likely to develop irreversible ischemic colitis. We report a rare case of ischemic colitis after the closure of a temporary ileostomy for low anterior resection(LAR)of rectal cancer in a dialysis patient. A 77-year-old man undergoing maintenance dialysis was diagnosed as having colorectal cancer with a type 2 tumor at the anastomosis site of high anterior resection performed for sigmoid colon cancer 14 years ago. After undergoing excision which included the anastomosis site of the previous operation, LAR with anastomosis in the transverse colon and rectum and temporary ileostomy were performed. Seven months later, closure of the temporary ileostomy was performed, which resulted in ileus and septic shock. Computed tomography(CT)revealed inflammation in the colon on the oral side of the anastomosis, which was diagnosed as ischemic colitis. Ischemic colitis did not improve with conservative treatment, and fever reoccurred at each maintenance dialysis session. Therefore, ileostomy was performed again, but multiple organ failure due to disseminated intravascular coagulopathy(DIC)progressed and he died. It is considered that Hartmann's operation should be selected for dialysis patients with serious underlying diseases, and if ischemic colitis is observed after closure of the stoma temporary colostomy in such patients, the lesion site of ischemic colitis should be excised promptly and colostomy should be performed again.
ISSN:	0385-0684