A Case of Ileus due to Colon Cancer Associated with Portal Venous Gas, Obstructive Colitis and Perforating Peritonitis

We report an extremely rare, severe case of ileus due to colon cancer associated with portal venous gas, extensive intestinal necrosis, and perforating peritonitis. A 57-year-old man reporting severe abdominal pain and nausea during examination for ileus had abdominal distension, tenderness, and tachycardia on physical examination. Laboratory studies showed inflammation response and metabolic acidosis. Abdominal computed tomography showed ascites, free air, and portal venous gas. Emergency surgery found reddish-brown ascites with foul-smelling extensive intestinal necrosis from the ileum to the sigmoid colon. A tumor with circular stenosis was located at the sigmoid colon, and perforation was observed at the tumor. Due to severe circula-tion problems, he initially underwent a resection of the necrotic intestine, followed 37 hours later by second-look operation. Polymyxin B immobilized fiber column and other intensive cares for respiratory failure and disseminated intravascular coagulation were conducted postoperatively. The patient improved and was discharged 59 days after the first operation.