Moldovan R, Vlad N, Curca G, Borcea M, Ferariu D, Dimofte G, Tarcoveanu E
Gr.T. Popa University of Medicine and Pharmacy Iaşi, St. Spiridon Hospital, Iaşi, Romania.
Chirurgia (Bucur). 2013 May-Jun;108(3):396-9.
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.
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.
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.
坏死性结肠炎（NC）是左半结肠癌梗阻的一种罕见并发症，它是由于腔内压力升高继发血供受损导致肠壁缺血的结果。
一名患有严重合并症（ASA 4级）的70岁患者因肠梗阻入院。术中诊断为乙状结肠癌梗阻继发整个近端结肠广泛坏死。行全结肠切除术及末端回肠造口术。术后过程顺利，7个月后行回肠直肠吻合术关闭回肠造口。对讨论此类结肠炎的流行病学、发病机制、诊断和治疗方法的文献进行了综述。
坏死性结肠炎意味着诊断和治疗困难，尤其是从手术策略的角度来看。我们主张进行大范围的结肠切除术，超出坏死的宏观范围，以避免术后并发症。我们也认为分期手术是高危患者的一个不错选择。
