内容紹介
A Case of Sigmoid Colon Cancer It Was Found from Penetration of Sigmoid Diverticulum
Summary
A 52-year-old woman presented with sudden left lower abdominal pain, fever, and vomiting. As the symptom got improved immediately she went home then. She consulted our hospital with chief complaint of the left lower abdominal mass. Abdominal computed tomography revealed sigmoid colon cancer with abscess. She was diagnosed with sigmoid colon cancer via colonoscopy. Sigmoidectomy including partial resection of the abdominal wall was performed(D3 lymphadenectomy). Surgical specimen showed penetration of diverticulum on mucous membrane of the lesion which had been thought of a abdominal wall permeation and a tumor of Ⅰsp type at anal side. Pathological examination showed diverticulitis with penetration and the tumor was tubular adenocarcinoma(tub1, pT1bpN0, pStageⅠ). We had doubted penetration of sigmoid colon cancer most, but the cause of penetration turned out to be diverticulitis. We experienced a case in which we could performed surgery of sigmoid colon cancer and penetration of diverticulum at the same time.
要旨
症例は52歳,女性。突然の左下腹部痛,発熱,嘔吐で近医を受診し軽快したため経過観察していたが,左下腹部腫瘤を触知し精査・加療目的で当院紹介となった。腹部CT検査でS状結腸穿通,腹腔内膿瘍の診断で保存的加療を行い,軽快し退院した。下部消化管内視鏡検査ではS状結腸に隆起性病変を認め,S状結腸癌,cT4b(腹壁),cN1cM0,cStage Ⅲaの診断で手術を施行した。S状結腸と腹壁の強固な浸潤を認め,S状結腸切除術[D3郭清,double stapling technique(DST)再建]を施行した。摘出標本では腹壁浸潤部は憩室穿通であり,肛門側にⅠsp型の腫瘍を認めた。病理検査所見は憩室穿通の診断で,腫瘍はtub1,pT1bpN0,pStageⅠであった。術前S状結腸癌穿通が疑われたが,穿通の原因は憩室炎であった。今回,S状結腸癌の根治手術も同時に行うことができた1例を経験した。
目次
Summary
A 52-year-old woman presented with sudden left lower abdominal pain, fever, and vomiting. As the symptom got improved immediately she went home then. She consulted our hospital with chief complaint of the left lower abdominal mass. Abdominal computed tomography revealed sigmoid colon cancer with abscess. She was diagnosed with sigmoid colon cancer via colonoscopy. Sigmoidectomy including partial resection of the abdominal wall was performed(D3 lymphadenectomy). Surgical specimen showed penetration of diverticulum on mucous membrane of the lesion which had been thought of a abdominal wall permeation and a tumor of Ⅰsp type at anal side. Pathological examination showed diverticulitis with penetration and the tumor was tubular adenocarcinoma(tub1, pT1bpN0, pStageⅠ). We had doubted penetration of sigmoid colon cancer most, but the cause of penetration turned out to be diverticulitis. We experienced a case in which we could performed surgery of sigmoid colon cancer and penetration of diverticulum at the same time.
要旨
症例は52歳,女性。突然の左下腹部痛,発熱,嘔吐で近医を受診し軽快したため経過観察していたが,左下腹部腫瘤を触知し精査・加療目的で当院紹介となった。腹部CT検査でS状結腸穿通,腹腔内膿瘍の診断で保存的加療を行い,軽快し退院した。下部消化管内視鏡検査ではS状結腸に隆起性病変を認め,S状結腸癌,cT4b(腹壁),cN1cM0,cStage Ⅲaの診断で手術を施行した。S状結腸と腹壁の強固な浸潤を認め,S状結腸切除術[D3郭清,double stapling technique(DST)再建]を施行した。摘出標本では腹壁浸潤部は憩室穿通であり,肛門側にⅠsp型の腫瘍を認めた。病理検査所見は憩室穿通の診断で,腫瘍はtub1,pT1bpN0,pStageⅠであった。術前S状結腸癌穿通が疑われたが,穿通の原因は憩室炎であった。今回,S状結腸癌の根治手術も同時に行うことができた1例を経験した。