内容紹介
Summary
A 61-year-old man with a diagnosis of rectal cancer underwent assisted laparoscopic rectal amputation. Recurrence occurred, and treatment with FOLFIRI plus bevacizumab was initiated at our department. After 12 treatment courses, he developed abdominal pain at home. Emergency surgery was performed for the stoma perforation. We confirmed the diverticular perforation in the resected specimen. In our case, we found a para-stoma hernia and considered it to be the cause of perforation together with bevacizumab administration. Molecular-targeted drugs contribute to improving treatment outcomes in malignant tumors, but specific adverse events such as perforation have been reported. In addition, as causes of sigmoid colon perforation such as that of the stoma, cases associated with intestinal operation, constipation, and para-stoma hernia are suggested. In our case of hyperpolarization due to a para-stoma hernia, administration of bevacizumab was considered the cause of the perforation. This was a case that could be rescued with surgery.
要旨
症例は61歳,男性。直腸癌の診断で腹腔鏡補助下腹会陰式直腸切断術を施行後,再発を認め当科外来にてFOLFIRI+ベバシズマブ(12コース終了)加療中であった。自宅で腹痛を自覚したため,当科を受診した。精査にてS状結腸人工肛門穿孔を認め,緊急手術を施行した。切除標本に憩室穿孔を認めた。自験例は傍ストーマヘルニアを認め,ベバシズマブ投与と合わせて穿孔の原因と考えた。分子標的薬は悪性腫瘍に対する治療成績の向上に寄与する一方で,穿孔などの特有の有害事象が報告されている。また,ストーマとして挙上されたS状結腸穿孔の原因としては,洗腸操作,傍ストーマヘルニア,便秘症などが考えられる。自験例では傍ストーマヘルニアによる内圧亢進,ベバシズマブ投与,憩室の存在が穿孔の原因と考えられ,手術によって救命できた症例である。
目次
A 61-year-old man with a diagnosis of rectal cancer underwent assisted laparoscopic rectal amputation. Recurrence occurred, and treatment with FOLFIRI plus bevacizumab was initiated at our department. After 12 treatment courses, he developed abdominal pain at home. Emergency surgery was performed for the stoma perforation. We confirmed the diverticular perforation in the resected specimen. In our case, we found a para-stoma hernia and considered it to be the cause of perforation together with bevacizumab administration. Molecular-targeted drugs contribute to improving treatment outcomes in malignant tumors, but specific adverse events such as perforation have been reported. In addition, as causes of sigmoid colon perforation such as that of the stoma, cases associated with intestinal operation, constipation, and para-stoma hernia are suggested. In our case of hyperpolarization due to a para-stoma hernia, administration of bevacizumab was considered the cause of the perforation. This was a case that could be rescued with surgery.
要旨
症例は61歳,男性。直腸癌の診断で腹腔鏡補助下腹会陰式直腸切断術を施行後,再発を認め当科外来にてFOLFIRI+ベバシズマブ(12コース終了)加療中であった。自宅で腹痛を自覚したため,当科を受診した。精査にてS状結腸人工肛門穿孔を認め,緊急手術を施行した。切除標本に憩室穿孔を認めた。自験例は傍ストーマヘルニアを認め,ベバシズマブ投与と合わせて穿孔の原因と考えた。分子標的薬は悪性腫瘍に対する治療成績の向上に寄与する一方で,穿孔などの特有の有害事象が報告されている。また,ストーマとして挙上されたS状結腸穿孔の原因としては,洗腸操作,傍ストーマヘルニア,便秘症などが考えられる。自験例では傍ストーマヘルニアによる内圧亢進,ベバシズマブ投与,憩室の存在が穿孔の原因と考えられ,手術によって救命できた症例である。