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症例は77歳男性で，胃癌，S状結腸癌，前立腺癌に対する手術歴を認め，腸閉塞を複数回発症した既往があった。嘔気・嘔吐と腹痛を主訴に外来受診となり，画像所見より腸閉塞と診断され入院となった。イレウス管を挿入したが，減圧効果は不十分で状態は改善しなかった。第6病日，急に腹痛と腹膜刺激症状が出現し，CTで腹腔内遊離ガスと腹水を認め，穿孔性腹膜炎と診断した。緊急手術を行い，腹腔内には独特の腐敗臭を伴う緑黄色腹水が多量にあり，Treitzから50cm肛門側の空腸に径5mm程の穿孔部位を認めた。また，回盲部より80cm口側の回腸が癒着により閉塞しており，腹腔内を洗浄後に回腸の閉塞を解除し，穿孔部位で双孔式空腸ストマを造設して手術を終了した。術後は敗血症性ショック，播種性血管内凝固症候群（以下DIC）を発症したが，抗菌薬とリコンビナントトロンボモジュリンの投与，polymyxin–B direct hemoperfusionの使用による集中治療により救命し得た。腹水および血液の培養よりAeromonas hydrophila（以下A. hydrophila）が検出され，A. hydrophila敗血症により重症化したと判断した。A. hydrophila敗血症は急激な経過をたどって重篤化すると報告されている。本邦での穿孔性腹膜炎によるA. hydrophila敗血症は稀であるため，文献的考察を加え報告する。 The patient was a 77–year–old male who underwent abdominal surgeries for gastric cancer, sigmoid colon cancer and prostate cancer. Also he had suffered from recurrent ileus for several years. He presented with vomiting and abdominal pain at the emergency room of our hospital. He was admitted because diagnosed with ileus on computed tomography (CT). Though ileus tube was inserted, the ileus symptom was not improved enough. On the 6thday after admission, he presented sudden abdominal pain and abdominal guarding, and was diagnosed with perforation peritonitis on CT. We performed emergency surgery. We found a lot of greenish yellow ascites fluid with the unique putrid odor and the isolated jejunal perforation of around 5mm in diameter, approximately 50cm distal to the ligament of Treitz. In addition, we found the small bowel obstruction due to adhesions in the ileum of 80cm proximal to the ileocecal junction. We performed peritoneal lavage and drainage, adhesiolysis, constructed jejunostomy using the perforated site. Although he developed septic shock and DIC, he was improved by intensive care such as using antibiotics, rTM and PMX–DHP. Aeromonas hydrophilawas detected in the ascites and the blood culture afterward. A. hydrophilasepsis is known to become very serious. Also perforation peritonitis due to A. hydrophilais very rare. We here report a clitical case of A. hydrophilasepsis and DIC following secondary perforation peritonitis.