A Case of Criticall Illeness Polyneuropathy after Surgery for Perforated Rectal Cancer

We report a case of critical illness polyneuropathy (CIP) after surgery. A 49-year-old women diagnosed with diffuse peritonitis due to perforation of rectal cancer suffered from multiple organ failure (MOF) just after surgery, so we undertook hemoabsorption (PMX) and continuous hemodiafiltration (CHDF). Her consciousness improved on 50 postoperative day, and she recovered form MOF. She was weaned from the respirator but with severe flaccid tetraparesis. Neurological examination showed an absence of the deep tendon reflex. Computed tomogaraphy (CT) showed no organic change. Total proteiin of the cerebrospinal fluid was slighthy elevated. Serum Ig-G class antibodies to gangliosides were not detected. Sensory nerve action potential (SNAP) was severely decreased. Her limb strength improved (MMT3/5), but she was not able to swallow or speak 4 months after surgery. We diagnosed her condition as CIP complicated by severe sepsis. CIP is an acute axonal neuropathy that develops duriing treatment of patients with severe ill such as sepsis and SIRS. While there are many papers about CIP in Europe, only a few cases were reported in Japan.