内容紹介
Summary
A 50-year old male patient chose to have elective surgery for obstructive rectal cancer. Before undergoing surgery, he had a self-expandable metallic stent(SEMS)placed to relieve a colonic obstruction. He was discharged from our hospital after the elective surgery without surgical complications. In our outpatient clinic, he was prescribed UFT/LV for adjuvant chemotherapy. Eight months after surgery, he came back to the hospital complaining of abdominal distension, abdominal pain and constipation. A diagnosis of local recurrence of rectal cancer, peritoneal metastasis and metastatic liver cancer was confirmed. He was admitted to have the bowel obstruction relieved by having a SEMS placed. The procedure was successful in relieving the bowel obstruction and the patient began FOLFIRI plus bevacizumab as chemotherapy. Through this case, we were able to see that SEMS placement can circumvent emergency surgery and prevent the formation of a stoma by relieving a colonic obstruction. A SEMS placement can also lead to positive benefits such as faster treatment and therapy for palliative cases.
要旨
症例は50歳,男性。閉塞性S状結腸癌に対し大腸ステントを留置後にS状結腸切除術を施行した。8か月後に局所再発による腸閉塞を発症したため再度大腸ステント留置を施行した。精査にてS状結腸癌術後局所再発,多発肝転移,腹膜播種の診断となり,速やかにFOLFIRI+bevacizumabを使用した化学療法を開始した。再度の大腸ステント留置により人工肛門造設を回避し,QOLの改善ならびにスムーズな後治療の移行が可能であった。化学療法に伴う合併症は認めず,大腸ステント留置後の化学療法は検討可能な治療戦略の一つと考えられた。
目次
A 50-year old male patient chose to have elective surgery for obstructive rectal cancer. Before undergoing surgery, he had a self-expandable metallic stent(SEMS)placed to relieve a colonic obstruction. He was discharged from our hospital after the elective surgery without surgical complications. In our outpatient clinic, he was prescribed UFT/LV for adjuvant chemotherapy. Eight months after surgery, he came back to the hospital complaining of abdominal distension, abdominal pain and constipation. A diagnosis of local recurrence of rectal cancer, peritoneal metastasis and metastatic liver cancer was confirmed. He was admitted to have the bowel obstruction relieved by having a SEMS placed. The procedure was successful in relieving the bowel obstruction and the patient began FOLFIRI plus bevacizumab as chemotherapy. Through this case, we were able to see that SEMS placement can circumvent emergency surgery and prevent the formation of a stoma by relieving a colonic obstruction. A SEMS placement can also lead to positive benefits such as faster treatment and therapy for palliative cases.
要旨
症例は50歳,男性。閉塞性S状結腸癌に対し大腸ステントを留置後にS状結腸切除術を施行した。8か月後に局所再発による腸閉塞を発症したため再度大腸ステント留置を施行した。精査にてS状結腸癌術後局所再発,多発肝転移,腹膜播種の診断となり,速やかにFOLFIRI+bevacizumabを使用した化学療法を開始した。再度の大腸ステント留置により人工肛門造設を回避し,QOLの改善ならびにスムーズな後治療の移行が可能であった。化学療法に伴う合併症は認めず,大腸ステント留置後の化学療法は検討可能な治療戦略の一つと考えられた。