Contributed by Debra L. Callahan, MD
Published on line in July 1998
The patient was a 74-year-old man with a history of diabetes mellitus, coronary artery disease, inferior wall myocardial infarction, peripheral vascular disease, hypertension, and hypercholesterolemia. He was admitted for a left femoral-popliteal bypass graft. Postoperatively, his foot remained ischemic and he was treated with antibiotics. Three days later he developed leukocytosis, tachypnea, diarrhea, and abdominal distension. Radiologically, his colon was markedly dilated and his small intestine was scarred. His respiratory function worsened and he was transferred to the intensive care unit and intubated. He was diagnosed with colonic ischemia and underwent a colectomy with ileostomy. Postoperatively, the patient exhibited multiple problems including sepsis, hemodynamic instability with hypotension and atrial fibrillation, respiratory failure, renal failure, and coagulopathy with thrombocytopenia. He died two weeks after admission secondary to sepsis and shock.