Lethal obstructive colitis: how and when patients with colonic obstruction should be prevented from falling into a lethal condition.
OBJECTIVE
The objective of this study is to clarify the pathological condition and treatment strategy of lethal obstructive colitis (LOC), which is defined as obstructive colitis with severe shock or septic shock.


METHODS
We examined 5 patients with LOC (colorectal cancer or suspected in 2, fecal impaction in 2, and volvulus in 1) and evaluated their pathophysiology and management strategy from their medical records.


RESULTS
Emergency operations were performed within 150 minutes from arrival in all cases. Three were saved by repeat operations and 2 died. The systolic pressure of both survived and deceased patients were under 62 or palpable only on the common carotid artery, and there was no difference between survived and deceased patients. The mean pulse rate of the deceased patients was 76.5 while survived 117.7. Two deceased patients presented unconsciousness or conscious disorder while survived patients showed clear consciousness. The 2 deceased patients fell into VT just after arrival or during the operation.


CONCLUSIONS
In managing colonic obstruction, we should be aware of this potentially lethal disease and surgical treatment should be performed as soon as possible before the patients fall into LOC. Early diagnosis and early aggressive surgery is essential for managing LOC.
Moriwaki
Yoshihiro
Y
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan. qqc3@urahp.yokohama-cu.ac.jp
Sugiyama
Mitsugi
M
Toyoda
Hiroshi
H
Kosuge
Takayuki
T
Arata
Sinju
S
Iwashita
Masayuki
M
Suzuki
Noriyuki
N
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015331:Cohort Studies; D003082:Colectomy; D003092:Colitis / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007415:Intestinal Obstruction / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*