Case description
An 80-year old patient living with her son-in-law and grandson in Iwaki City, Fukushima, with chronic renal diseases of unknown cause, found a lump on the top of her right nipple and initially visited her primary physician in March 2019. She was then referred to our breast surgery outpatient office on June 17, 2019 after several consultation cancellations. An in-depth diagnostic workup confirmed cancer of the right breast with anatomical clinical stage of cT2N0M0 StageⅡA. We carried out mastectomy, sentinel lymph node biopsy with a positive lymph node metastasis, and subsequent axillary resection on September 25, 2019. The postoperative condition was stable, and she was discharged on October 11, 2019, which was the day before Typhoon Hagibis hit Iwaki City (post-operative day 16). Although she was advised to stay in the hospital until the typhoon passed by the city, she insisted on discharge that day.
At midnight on October 12, 2019, the typhoon heavily hit the city and destroyed 5,927 residences and 3,111 non-residential buildings, submerged 5,721 buildings, and killed 12 people. Her single-story residence was located 13 meters above sea level and only 100 meters away from the embarkments running along the Natsui River. The flood hazard map that estimates areas that would be submerged by floods with a scale of once in one thousand years is open access on the municipality website and clearly showed that her residence would become submerged up to 5 to 10 meters high due to overflow of the nearby Natui River. This occurred because the typhoon destroyed several of the river’s embarkments at 12:30am on October 13, 2019. While Iwaki City issued an evacuation order for those living around the river at 9:40pm on October 12, 2019, she reportedly did not evacuate from her residence because she was not aware of that warning. The flood water submerged her residence soon after the destruction of embarkments when she was asleep. The water level rapidly reached approximately two meters high, and she managed to survive by climbing on furniture her son-in-law piled up for her. Despite her efforts to cover her wound, it was immersed by contaminated flood water. The water smelled rotten, probably because of sewage that overflowed from the sewers, given that scattered manhole covers were observed around her residence the next day.
On October 13, 2019, she complained of appetite loss and visited our emergency department the next day (October 14, 2019). On physical examination, she was afebrile and her surgical site was not apparently infected, but she was hospitalized due to appetite loss and destruction of her residence. After admission, her surgical site gradually became red, swollen, and edematous, highly suggestive of secondary infection. On October 16, we inserted a drainage tube into the surgical wound and started administration of cefazolin 1g three times per day. We failed to take a culture of the fluid sample. Further discussion revealed that she had not carefully read the flood hazard map before the typhoon. Her condition gradually improved and she was discharged on November 5, 2019. After discharge, she abandoned her original residence because of persistent smells and moved to a nearby apartment building following several relocations.