A Patient with Pseudomembranous Enteritis and Penetrating Necrosis Who Difficult to Select a Reasonable Surgery

A 54-year-old women with a 20-year history of diabetes seen. On May 2, 2002, for abdominal pain and diarrhea was given. An antibiotic and an antidiarrheal agent, but showed no improvement. She was then treated under a tentative diagnosis of bacterial enteritis. On May 12, muscular defense appeared. Computed tomography (CT) showed penetrating edematous changes in the ascending colon, sigmoid colon, and rectum, and ascitis, necessitating emergency surgery under a diagnosis of peritonitis. A necrotic focus observed on the serous membrane of the ascending colon, was resected. No abnormalities were seen on the serous membrane of the sigmoid colon or rectum. Culture with pseudomembrane-removing solution confirmed methycillinresistant staphylococcus aureus (MRSA) but the patient was negative for CD toxin. Due to a lack of improvement, she underwent total extirpation of the rectum and anal canal, resection of the peripheral tissue for concurrent Fournier's syndrome, and other procedures, for total of 4 times, to no avail, and died on June 13. We treated a patient with extensive penetrating colorectal necrosis without underlying disease that may have been due to microangiopathy such as collagen disease. In such patients, early diagnosis and complete removal of necrotic tissues are essential but the prognosis may be poor.