内容紹介
Summary
Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6 months after the operation.
要旨
症例は79歳,男性。下腹部痛を主訴に外来を受診した。腹部所見では下腹部を中心に強い圧痛と反跳痛を認めた。血液検査でWBC 11,320/μL,CRP 1.06 mg/dLと炎症反応の上昇を認めた。腹部単純CT検査で腹腔内遊離ガスと腹水の貯留を伴う小腸壁の肥厚を認めた。以上より,小腸穿孔による腹膜炎と診断し緊急開腹手術を行った。空腸にピンホール様の穿孔部を認め,小腸部分切除を行った。摘出標本を確認すると2 cmの潰瘍性病変を認めた。病理組織学的結果で肺腺癌の小腸転移が疑われた。退院後の胸部単純CT検査で左肺S6に3 cmの網状影を認め,またPET-CT検査で同部にSUVmax 3.18の集積を認めた。以上より,小腸転移を伴った肺腺癌,pT2aN0M1b,pStage ⅣAと診断した。その結果,化学療法を開始し術後 6か月生存中である。小腸転移の穿孔が初発症状である肺癌はまれであり,文献的考察を加えて報告する。
目次
Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6 months after the operation.
要旨
症例は79歳,男性。下腹部痛を主訴に外来を受診した。腹部所見では下腹部を中心に強い圧痛と反跳痛を認めた。血液検査でWBC 11,320/μL,CRP 1.06 mg/dLと炎症反応の上昇を認めた。腹部単純CT検査で腹腔内遊離ガスと腹水の貯留を伴う小腸壁の肥厚を認めた。以上より,小腸穿孔による腹膜炎と診断し緊急開腹手術を行った。空腸にピンホール様の穿孔部を認め,小腸部分切除を行った。摘出標本を確認すると2 cmの潰瘍性病変を認めた。病理組織学的結果で肺腺癌の小腸転移が疑われた。退院後の胸部単純CT検査で左肺S6に3 cmの網状影を認め,またPET-CT検査で同部にSUVmax 3.18の集積を認めた。以上より,小腸転移を伴った肺腺癌,pT2aN0M1b,pStage ⅣAと診断した。その結果,化学療法を開始し術後 6か月生存中である。小腸転移の穿孔が初発症状である肺癌はまれであり,文献的考察を加えて報告する。