内容紹介
Summary
A 56-year-old woman was diagnosed with rectal cancer and liver metastases(Stage Ⅳ), and underwent low anterior resection and laparoscopic partial hepatectomy. The patient received adjuvant chemotherapy(mFOLFOX6 for 24 weeks), but developed multiple lung metastases 11 months later. Before undergoing a pulmonary resection, the patient presented with acute small bowel obstruction. Abdominal computed tomography showed small bowel stenosis due to a tumor, and we suspected peritoneal metastases from the rectal tumor. We performed partial resection of the small intestine, and histopathological examination revealed a primary small bowel tumor. The patient was discharged to her home without complications, and later underwent pulmonary resections for bilateral lung metastases. We usually suspect that small bowel obstruction is due to peritoneal metastases in patients with advanced colorectal tumors, but must consider the rare possibility of a separate primary small bowel tumor, especially in patients with a solitary lesion. We report a rare primary small bowel tumor after FOLFOX treatment in a patient with Stage Ⅳ rectal cancer.
要旨
症例は56歳,女性。直腸癌,同時性肝転移に対して低位前方切除術,二期的腹腔鏡下肝部分切除術を施行した。術後補助化学療法としてmFOLFOX6を24週で完遂した。術後11か月に両側肺転移が出現し切除予定であったが,腸閉塞にて入院した。腹部CT検査で腫瘍による小腸狭窄を認め,腹膜播種を疑った。開腹手術を施行し,腹膜播種は認めず閉塞起点の小腸腫瘍を切除した。病理は原発性小腸癌の診断であった。術後経過は良好で,両側肺転移に対し肺部分切除術を施行した。Stage Ⅳ大腸癌の術後小腸狭窄では通常は腹膜播種を疑うが,単発の場合は小腸癌の重複もまれではあるが存在する。mFOLFOX6治療後に両側肺転移と同時に原発性小腸癌を認めたまれな症例を経験した。
目次
A 56-year-old woman was diagnosed with rectal cancer and liver metastases(Stage Ⅳ), and underwent low anterior resection and laparoscopic partial hepatectomy. The patient received adjuvant chemotherapy(mFOLFOX6 for 24 weeks), but developed multiple lung metastases 11 months later. Before undergoing a pulmonary resection, the patient presented with acute small bowel obstruction. Abdominal computed tomography showed small bowel stenosis due to a tumor, and we suspected peritoneal metastases from the rectal tumor. We performed partial resection of the small intestine, and histopathological examination revealed a primary small bowel tumor. The patient was discharged to her home without complications, and later underwent pulmonary resections for bilateral lung metastases. We usually suspect that small bowel obstruction is due to peritoneal metastases in patients with advanced colorectal tumors, but must consider the rare possibility of a separate primary small bowel tumor, especially in patients with a solitary lesion. We report a rare primary small bowel tumor after FOLFOX treatment in a patient with Stage Ⅳ rectal cancer.
要旨
症例は56歳,女性。直腸癌,同時性肝転移に対して低位前方切除術,二期的腹腔鏡下肝部分切除術を施行した。術後補助化学療法としてmFOLFOX6を24週で完遂した。術後11か月に両側肺転移が出現し切除予定であったが,腸閉塞にて入院した。腹部CT検査で腫瘍による小腸狭窄を認め,腹膜播種を疑った。開腹手術を施行し,腹膜播種は認めず閉塞起点の小腸腫瘍を切除した。病理は原発性小腸癌の診断であった。術後経過は良好で,両側肺転移に対し肺部分切除術を施行した。Stage Ⅳ大腸癌の術後小腸狭窄では通常は腹膜播種を疑うが,単発の場合は小腸癌の重複もまれではあるが存在する。mFOLFOX6治療後に両側肺転移と同時に原発性小腸癌を認めたまれな症例を経験した。