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要旨症例は56歳の女性で，ショック状態のため，他院から紹介となる。初期輸液やカテコラミンに反応せず，一時心肺停止になった。蘇生後もショック状態を認め，Direct hemoperfusion with polymyxin B immobilized fiberを導入した。CT検査上，腹水と腸管壁の肥厚を認めたため，診断的腹腔洗浄を行った。白色に混濁した腹水を認め，緊急手術を施行した。膿性混濁腹水と子宮に膿苔を認めたが，腸管穿孔は認めなかったため，腹腔内を洗浄後，持続灌流洗浄を開始し集中治療を継続した。血液，腹水培養検査上，Streptococcus pyogenesを検出し，Streptococcal Toxic Shock Syndrome（STSS）の診断基準を満たした。その後，徐々に状態は安定し，16病日に一般病棟に転棟した。本症例はAcute Physiology and Chronic Health Evaluation II score 49点，Sequential Organ Failure Assessment score 18点であった。Streptococcus pyogenesによる原発性腹膜炎は稀な疾患であるが，STSSを発症すると急激に悪化し心停止にもなる重篤な疾患である。救命のためには，早期診断，迅速な外科的治療および適切な集中治療が必要であると考えられた。

Stercoral obstructive colitis has non-specific physical and imaging findings, and it is often difficult to evaluate necrosis. This study aims to clarify the surgical indications and strategy for stercoral obstructive colitis. Subjects: Thirty cases of stercoral obstructive colitis were divided into two groups based on the presence or absence of necrosis. Vital signs, abdominal findings, CT findings, and blood gas findings were compared, and we investigated the predictors of necrosis. Additionally, in surgical cases, the surgical strategy was examined based on the frequency of necrosis progression and the association between CT findings and necrosis range. Results: There were no significant difference in the signs of peritoneal irritation or CT findings between the cases in the necrotic and non-necrotic groups. The shock index and lactate levels in the blood (8.3 vs. 3.8mmol/L, p<0.01) showed a significant difference, where the cut-off point of lactate was 5.8mmol/L (AUC 0.862, 95%CI 0.727-0.996). There were 18 surgical cases, out of which four had necrosis progression. The necrotic area was 84.6% consistent with the intestinal dilation area in the CT. Conclusion: It is difficult to detect colon necrosis in stercoral obstructive colitis from abdominal and CT findings. However, blood gas findings are useful. If the lactate level is 5.8mmol/L or higher, necrosis should be suspected, and an exploratory laparotomy is desirable. Dilated intestine has a high risk of necrosis, and if the dilation continues, it is desirable to confirm necrosis progression by planned re-operation.

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