A case of obstructive colitis caused by possible colostomy dysfunction

A case of obstructive colitis caused by possible stricture of colostomy is herein reported. A 58 year old female with an obstructive sigmoid colon cancer underwent an emergency descending decompression colostomy. At laparotomy, the colon proximal to the carcinoma was markedly distended and the bowel wall was thin, but the serosa appeared normal. Postoperatively, however, abdominal pain and distension persisted and low grade fever developed. Diarrhea through the colostomy continued. Nine days after the initial surgery, she underwent a left hemicolectomy. An abnormally thickened segment was identified in the resected specimen; normal mucosa was lost and several pseudopolyps were scattered. Histopathological findings of the abnormal segment were consistent with obstructive colitis. A preserved segment of normal mucosa intervened between the site of colostomy and the abnormal segment of obstructive colitis. A possible stenosis of the colostomy was considered to have caused colostomy dysfunction and subsequent obstructive colitis. She was complicated with anastomotic leakage due to the diseased colon being used for anastomosis. Obstructive colitis should be kept in mind in patients with obstructive colonic carcinomas who complain of persistent abdominal pain, distension and diarrhea in the early postoperative period after colostomy.