内容紹介
Summary
A 76-year-old man visited our hospital with complaints of appetite loss and diarrhea. Abdominal computed tomography(CT)showed a large transverse colon tumor at the splenic flexure and a gastrocolic fistula. Upper gastrointestinal series and gastroscopy demonstrated a type 2 tumor in the transverse colon and a gastrocolic fistula as the scope was inserted into the transverse colon. Colonoscopy showed a type 2 tumor of the rectum. Based on the diagnosis of advanced transverse colon cancer with gastrocolic fistula and synchronous rectal cancer, a one-stage curative operation was performed. Pathologically, both cancers were well-differentiated adenocarcinomas, but the transvers colon cancer was partially mucinous. Lymph node metastasis was absent. Gastrocolic fistula complicating colon cancer is rare, to our knowledge, with only 29 cases reported in Japan. A curative operation was performed in 73% of these cases, including ours, and lymph node metastasis was observed in only 22%. This suggests that colon cancer with a gastrocolic fistula might undergo less lymph node metastasis despite increased invasion depth, and that a curative operation for the colon cancer and gastrocolic fistula should be considered.
要旨
症例は76歳,男性。食欲不振,下痢のため受診した。CT検査で横行結腸脾弯曲部に腫瘤を認め,胃と瘻孔形成が疑われた。上部消化管造影,上部内視鏡検査でtype 2横行結腸癌および胃結腸瘻を確認した。下部内視鏡検査でRa領域にtype 2直腸癌を認めたため,胃結腸瘻を伴う横行結腸癌および同時性直腸癌の診断で,一期的に根治切除術を行った。病理検査では,ともに高分化型腺癌であったが横行結腸癌は一部粘液癌成分を認めた。いずれもリンパ節転移は認めなかった。胃結腸瘻を来す結腸癌はまれであるが自験例を加えた本邦報告30例の検討を行ったところ,深達度に比してリンパ節転移率が低かったことから積極的な浸潤臓器合併切除が望ましいと思われる。
目次
A 76-year-old man visited our hospital with complaints of appetite loss and diarrhea. Abdominal computed tomography(CT)showed a large transverse colon tumor at the splenic flexure and a gastrocolic fistula. Upper gastrointestinal series and gastroscopy demonstrated a type 2 tumor in the transverse colon and a gastrocolic fistula as the scope was inserted into the transverse colon. Colonoscopy showed a type 2 tumor of the rectum. Based on the diagnosis of advanced transverse colon cancer with gastrocolic fistula and synchronous rectal cancer, a one-stage curative operation was performed. Pathologically, both cancers were well-differentiated adenocarcinomas, but the transvers colon cancer was partially mucinous. Lymph node metastasis was absent. Gastrocolic fistula complicating colon cancer is rare, to our knowledge, with only 29 cases reported in Japan. A curative operation was performed in 73% of these cases, including ours, and lymph node metastasis was observed in only 22%. This suggests that colon cancer with a gastrocolic fistula might undergo less lymph node metastasis despite increased invasion depth, and that a curative operation for the colon cancer and gastrocolic fistula should be considered.
要旨
症例は76歳,男性。食欲不振,下痢のため受診した。CT検査で横行結腸脾弯曲部に腫瘤を認め,胃と瘻孔形成が疑われた。上部消化管造影,上部内視鏡検査でtype 2横行結腸癌および胃結腸瘻を確認した。下部内視鏡検査でRa領域にtype 2直腸癌を認めたため,胃結腸瘻を伴う横行結腸癌および同時性直腸癌の診断で,一期的に根治切除術を行った。病理検査では,ともに高分化型腺癌であったが横行結腸癌は一部粘液癌成分を認めた。いずれもリンパ節転移は認めなかった。胃結腸瘻を来す結腸癌はまれであるが自験例を加えた本邦報告30例の検討を行ったところ,深達度に比してリンパ節転移率が低かったことから積極的な浸潤臓器合併切除が望ましいと思われる。