内容紹介
Summary
A 74-year-old man visited his local clinic complaining of abdominal pain that persisted for three days. He was diagnosed with diffuse peritonitis and was transported to our hospital. Contrast computed tomography(CT)showed gastric perforation and a tumor in the sigmoid colon with left obturator lymph node metastasis. He was diagnosed with diffuse peritonitis resulting from gastric perforation and performed emergent surgery. As the size of the gastric perforation was large, we performed distal gastrectomy and transverse colostomy. He was discharged without any complications, and a total of 6 courses of SOX with a bevacizumab regimen were administered postoperatively. CT following chemotherapy showed shrinkage of the lesion. He was admitted again for sigmoidectomy with left lateral lymph node resection and discharged from the hospital on postoperative day 8. We administered 2 courses of SOX regimen after the surgery. He remains alive with no recurrence 27 months after the first surgery.
要旨
症例は74歳,男性。3日間持続する腹痛を主訴に近医を受診し,汎発性腹膜炎の診断で当院に緊急搬送された。造影CT検査で胃穿孔および左閉鎖リンパ節腫大を伴うS状結腸腫瘍を認めた。胃穿孔に伴う汎発性腹膜炎に対して,緊急で幽門側胃切除を行った。S状結腸腫瘍は後腹膜に強く固定されていたため切除せず,横行結腸で人工肛門を造設した。術後1か月よりbevacizumab併用SOX療法を開始した。6コース施行後に腫瘍縮小を認め,S状結腸切除および左閉鎖リンパ節の摘出を行った。術後SOX療法を2コース追加した。現在,初回手術より27か月経過しているが,無再発生存中である。腹膜炎併発時の進行癌治療として,2期的治療を選択したことが良好な予後に寄与したと考えられた。
目次
A 74-year-old man visited his local clinic complaining of abdominal pain that persisted for three days. He was diagnosed with diffuse peritonitis and was transported to our hospital. Contrast computed tomography(CT)showed gastric perforation and a tumor in the sigmoid colon with left obturator lymph node metastasis. He was diagnosed with diffuse peritonitis resulting from gastric perforation and performed emergent surgery. As the size of the gastric perforation was large, we performed distal gastrectomy and transverse colostomy. He was discharged without any complications, and a total of 6 courses of SOX with a bevacizumab regimen were administered postoperatively. CT following chemotherapy showed shrinkage of the lesion. He was admitted again for sigmoidectomy with left lateral lymph node resection and discharged from the hospital on postoperative day 8. We administered 2 courses of SOX regimen after the surgery. He remains alive with no recurrence 27 months after the first surgery.
要旨
症例は74歳,男性。3日間持続する腹痛を主訴に近医を受診し,汎発性腹膜炎の診断で当院に緊急搬送された。造影CT検査で胃穿孔および左閉鎖リンパ節腫大を伴うS状結腸腫瘍を認めた。胃穿孔に伴う汎発性腹膜炎に対して,緊急で幽門側胃切除を行った。S状結腸腫瘍は後腹膜に強く固定されていたため切除せず,横行結腸で人工肛門を造設した。術後1か月よりbevacizumab併用SOX療法を開始した。6コース施行後に腫瘍縮小を認め,S状結腸切除および左閉鎖リンパ節の摘出を行った。術後SOX療法を2コース追加した。現在,初回手術より27か月経過しているが,無再発生存中である。腹膜炎併発時の進行癌治療として,2期的治療を選択したことが良好な予後に寄与したと考えられた。