内容紹介
Summary
We report a 50-year-old man with local recurrence of descending colon cancer with ileus obstruction and brain metastasis, 2 years 6 months after initial resection due to perforation of descending colon cancer(Hartmann procedure, D2 lymph node resection, StageⅡ, tub2). He complained of left upper abdominal pain and abdominal fullness. He also complained of paresis of the right upper extremity and of experiencing convulsions 1 month before admission. He was diagnosed with local recurrence of descending colon cancer, based on findings of contrast radiography and the presence of colonic fiber. We subsequently performed transanal decompression as a bridge to surgery and performed partial resection of the local recurrence in the anastomosis at the descending colon and ileum involved with the cancer 2 weeks after decompression. In addition, multiple lung and liver metastases, and solitary brain metastasis(2.5 cm in size located in the left side of the parietal region)were detected by cerebral plain computed tomography. However, he refused both chemotherapy after surgery, as well as further surgery and/or radiation therapy for the brain metastasis. He desired to return to his home as soon as possible. In order to improve his quality of life(QOL), in-home treatment involving the best supportive care(BSC)conservative therapies-including, anticonvulsant and anti-intracranial hypertension drugs-were administered to prevent brain metastasis symptoms, such as paresis of the right upper extremities and convulsions. He was discharged from our hospital 14 days after surgery. Regrettably, he died due to bronchial asthma 75 days after palliative surgery in his home.
要旨
症例は50歳,男性。2年6か月前に穿孔性下行結腸癌にてHartmann手術(D2,StageⅡ,tub2)を受けたがその後来院しなかった。今回,大腸癌局所再発による大腸癌イレウスの診断で入院となった。なお,入院1か月前より右上肢不全麻痺,痙攣を認めていた。注腸造影検査および大腸内視鏡検査で下行結腸局所再発部に壁不整な全周性狭窄を認めたため,経肛門的イレウスチューブを挿入してイレウスを解除した。腸管減圧2週間後に下行結腸局所再発部および回腸浸潤部の部分切除術を行った。なお全身CT検査で多発性肺・肝転移,および左頭頂葉に広範囲な浮腫を伴った直径2.5 cmの腫瘍を認めた。患者は早期退院による在宅医療を希望し,全身化学療法は行わず脳転移も保存的治療で経過観察となった。すなわち脳転移症状に対しては手術や放射線療法は行わず,脳圧降下剤や抗痙攣剤を経静脈投与から経口剤へ変更し,best supportive care(BSC)として患者のquality of life(QOL)の改善をめざした。しかし退院後,慢性気管支喘息重積発作により術後75日目に死亡した。
目次
We report a 50-year-old man with local recurrence of descending colon cancer with ileus obstruction and brain metastasis, 2 years 6 months after initial resection due to perforation of descending colon cancer(Hartmann procedure, D2 lymph node resection, StageⅡ, tub2). He complained of left upper abdominal pain and abdominal fullness. He also complained of paresis of the right upper extremity and of experiencing convulsions 1 month before admission. He was diagnosed with local recurrence of descending colon cancer, based on findings of contrast radiography and the presence of colonic fiber. We subsequently performed transanal decompression as a bridge to surgery and performed partial resection of the local recurrence in the anastomosis at the descending colon and ileum involved with the cancer 2 weeks after decompression. In addition, multiple lung and liver metastases, and solitary brain metastasis(2.5 cm in size located in the left side of the parietal region)were detected by cerebral plain computed tomography. However, he refused both chemotherapy after surgery, as well as further surgery and/or radiation therapy for the brain metastasis. He desired to return to his home as soon as possible. In order to improve his quality of life(QOL), in-home treatment involving the best supportive care(BSC)conservative therapies-including, anticonvulsant and anti-intracranial hypertension drugs-were administered to prevent brain metastasis symptoms, such as paresis of the right upper extremities and convulsions. He was discharged from our hospital 14 days after surgery. Regrettably, he died due to bronchial asthma 75 days after palliative surgery in his home.
要旨
症例は50歳,男性。2年6か月前に穿孔性下行結腸癌にてHartmann手術(D2,StageⅡ,tub2)を受けたがその後来院しなかった。今回,大腸癌局所再発による大腸癌イレウスの診断で入院となった。なお,入院1か月前より右上肢不全麻痺,痙攣を認めていた。注腸造影検査および大腸内視鏡検査で下行結腸局所再発部に壁不整な全周性狭窄を認めたため,経肛門的イレウスチューブを挿入してイレウスを解除した。腸管減圧2週間後に下行結腸局所再発部および回腸浸潤部の部分切除術を行った。なお全身CT検査で多発性肺・肝転移,および左頭頂葉に広範囲な浮腫を伴った直径2.5 cmの腫瘍を認めた。患者は早期退院による在宅医療を希望し,全身化学療法は行わず脳転移も保存的治療で経過観察となった。すなわち脳転移症状に対しては手術や放射線療法は行わず,脳圧降下剤や抗痙攣剤を経静脈投与から経口剤へ変更し,best supportive care(BSC)として患者のquality of life(QOL)の改善をめざした。しかし退院後,慢性気管支喘息重積発作により術後75日目に死亡した。