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.