title: Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review.
abstract: BACKGROUND
  Necrotizing colitis (NC) is a rare complication of the obstructive cancer of the left colon and it is the result of intramural ischemia due to impairment of blood supply secondary to increased endoluminal pressure.
  
  
  METHODS
  A 70 years old patient with significant comorbidities (ASA 4) was admitted for intestinal obstruction.The extensive necrosis of the entire proximal colon secondary to an obstructive sigmoid colon cancer has been diagnosed intraoperatively. Total colectomy and terminal ileostomy have been performed. The postoperative course was uneventful and the ileostomy closure with ileo-rectal anastomosis was performed 7 months later. A review of the literature discussing the epidemiology, pathogenesis, diagnosis and therapeutic approach of this type of colitis, was performed.
  
  
  CONCLUSIONS
  NC implies diagnosis and therapeutic difficulties,especially from point of view of surgical strategy. We advocate of large colic resections, beyond the macroscopic limits of the necrosis in order to avoid the postoperative complications. We also consider seriate surgical procedures as a good choice for the high risk patients.
authors.affiliation: Gr.T. Popa University of Medicine and Pharmacy Iaşi, St. Spiridon Hospital, Iaşi, Romania. rmoldovanu@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Moldovan
authors.forename: N
authors.initials: N
authors.lastname: Vlad
authors.forename: G
authors.initials: G
authors.lastname: Curca
authors.forename: M
authors.initials: M
authors.lastname: Borcea
authors.forename: D
authors.initials: D
authors.lastname: Ferariu
authors.forename: G
authors.initials: G
authors.lastname: Dimofte
authors.forename: E
authors.initials: E
authors.lastname: Tarcoveanu
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D003082:Colectomy; D003092:Colitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012809:Colon, Sigmoid / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D009336:Necrosis; D012086:Reoperation; D012307:Risk Factors; D012811:Sigmoid Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome