KẾT QUẢ PHẪU THUẬT VÀ ĐIỀU TRỊ SỐC NHIỄM TRÙNG NHIỄM ĐỘC, HOẠI TỬ TOÀN BỘ ĐẠI TRÀNG TRÊN BỆNH NHÂN ĐÃ PHẪU THUẬT UNG THƯ TRỰC TRÀNG (ISCHEMIC COLITIS)

Abstract

Aim of study: Evaluation the clinical and paraclinical feature of ischemic colitis (IC) patient, diagnosis  and its  surgical and medical treatment. Patient and method: Restrospective study, case report. Result: Male, aged of 60 years old, hospitalization in K hospital due to abdominal pain and hematochezia without fever, vomit. Physical examination: tenderness and rebound tenderness. The rectal examination showed bright and marron stool. Nasogastric tube with marron liquid. Abdominal Xray showed air and liquid level of colon with intraabdominal liquid mesuring 41 mm. Abdominal CTScan revealed dilatation of colon and small bowel with intraabdominal liquid. Leukocystosis of 11,6 G/L Uremia 9,6 mmol/L.Creatininemia 108 Mmol/L, Glucose: 9,1 mmol/L; GOT 43,6 U/L. Peroperation lesion: Thickening and gangrene of ascending colon, transvere colon and descending colon. No evidence of superior mesenteric artery thrombosis and left colon artery thrombosis. Surgical procedure: Total colectomy with ileostomy, post operation  was in ICU with multiorgandysfunction syndrome and had hemodialysis twice a week. Consclusion: Ischemic colitis is abount 50-60%  total  ischemie of gastrointestinal tract and preponderance in left side. There were 3 types of lesion: Gangrene, thickening wall of colon and stenosis. The symptoms  were vague including abdominal pain and hematochezia. CT Scan and angiography may apear nomal in early and mild cases. Risk factors were diabetes, hypertension, dyslipidemia, abdominal aortic Aneurysm, peripheral vascular disease, heart faillure, use of aspirin and digoxin, hypoalbuminemia, constipation, hemodialysis... Colonoscopy could be performed in the absence of peritoneal signs. Medical treatment in 80,3%. The mortality of emergency colectomy in 39,8% in gangrene. The elective colectomy could be done in case of stricture of colon. Hypotesion was bad  preoperative pronostic factor.