内容紹介
Summary
A 79-year-old man was diagnosed with Stage ⅢB(T4N2M0)adenocarcinoma of the lung, administered. He suddenly developed abdominal pain with muscle guarding and rebound tenderness. An abdominal computed tomography scan revealed a thickened small bowel wall and mesenteric mass, as well as massive ascites and free air. He underwent an emergency laparotomy following a diagnosis of pan-peritonitis due to intestinal perforation. A partial resection of the small intestine and abdominal drainage were performed. The resected specimen included an ulcerative lesion on the mucosal surface. The pathological diagnosis was a metastasis of lung cancer. The patient died in hospice 29 days postoperatively. In the present case, however, surgery improved the patient's quality of life. Although lung cancer metastasis to the small bowel is associated with a poor prognosis, palliative surgery is indicated in otherwise fatal circumstances.
要旨
症例は79歳,男性。切除不能肺腺癌(T4N2M0,Stage ⅢB)と診断され,化学療法が施行されていた。経過中に突然の腹痛が出現し,当院へ緊急搬送された。腹部に筋性防御と反跳痛を認め,血液検査で高度炎症反応を認めた。腹部CT検査では,大量の腹水およびfree airを認めた。小腸の壁肥厚および小腸間膜内に腫瘤を認めた。穿孔性腹膜炎と診断し,緊急手術を施行した。小腸部分切除と腹腔内ドレナージを行った。切除標本では潰瘍を伴う腫瘍を認め,その中心に穿孔を認めた。病理組織学的検査で,肺癌の小腸転移と診断された。術後生存期間は29日であったが,終末期においても経口摂取は可能であった。
目次
A 79-year-old man was diagnosed with Stage ⅢB(T4N2M0)adenocarcinoma of the lung, administered. He suddenly developed abdominal pain with muscle guarding and rebound tenderness. An abdominal computed tomography scan revealed a thickened small bowel wall and mesenteric mass, as well as massive ascites and free air. He underwent an emergency laparotomy following a diagnosis of pan-peritonitis due to intestinal perforation. A partial resection of the small intestine and abdominal drainage were performed. The resected specimen included an ulcerative lesion on the mucosal surface. The pathological diagnosis was a metastasis of lung cancer. The patient died in hospice 29 days postoperatively. In the present case, however, surgery improved the patient's quality of life. Although lung cancer metastasis to the small bowel is associated with a poor prognosis, palliative surgery is indicated in otherwise fatal circumstances.
要旨
症例は79歳,男性。切除不能肺腺癌(T4N2M0,Stage ⅢB)と診断され,化学療法が施行されていた。経過中に突然の腹痛が出現し,当院へ緊急搬送された。腹部に筋性防御と反跳痛を認め,血液検査で高度炎症反応を認めた。腹部CT検査では,大量の腹水およびfree airを認めた。小腸の壁肥厚および小腸間膜内に腫瘤を認めた。穿孔性腹膜炎と診断し,緊急手術を施行した。小腸部分切除と腹腔内ドレナージを行った。切除標本では潰瘍を伴う腫瘍を認め,その中心に穿孔を認めた。病理組織学的検査で,肺癌の小腸転移と診断された。術後生存期間は29日であったが,終末期においても経口摂取は可能であった。