内容紹介
Summary
In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28 mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, StageⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3 mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.
要旨
症例は73歳,女性。以前より術後の腸閉塞を繰り返していた。20XX-1年12月腹部造影CT検査で脾静脈浸潤を伴う28mm大の膵尾部癌を認め,術前GEM/TS-1併用化学療法を施行するも皮疹,腸粘膜障害による血便で中止し,20XX年4月に膵体尾部切除術,2群リンパ節郭清を施行した。最終診断は脾静脈浸潤を伴う18 mm大の膵尾部癌で,T3,N0,M0,StageⅡAであった。同年7月に術後GEM単剤補助化学療法を施行したが,薬疹で中止し無治療で経過観察した。同年9月に腸閉塞が出現し軽快するも20XX+1年7月に腸閉塞が再燃し,入院となった。イレウス管造影で鼻腔より170 cmで小腸狭窄があり,腸閉塞解除術を施行した。Treitz靱帯より80 cm,100 cmと150 cmの小腸漿膜側で小腸を巻き込む腹壁と癒着した結節を認め,腹壁結節を含めて小腸切除と再建を行った。病理組織学的結果では腹壁結節内に3 mm程度の癌組織が認められ,腹膜播種による癒着性腸閉塞と診断した。切除可能な腹膜播種単発再発例は根治切除により,予後延長効果が期待できると考えられた。
目次
In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28 mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, StageⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3 mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.
要旨
症例は73歳,女性。以前より術後の腸閉塞を繰り返していた。20XX-1年12月腹部造影CT検査で脾静脈浸潤を伴う28mm大の膵尾部癌を認め,術前GEM/TS-1併用化学療法を施行するも皮疹,腸粘膜障害による血便で中止し,20XX年4月に膵体尾部切除術,2群リンパ節郭清を施行した。最終診断は脾静脈浸潤を伴う18 mm大の膵尾部癌で,T3,N0,M0,StageⅡAであった。同年7月に術後GEM単剤補助化学療法を施行したが,薬疹で中止し無治療で経過観察した。同年9月に腸閉塞が出現し軽快するも20XX+1年7月に腸閉塞が再燃し,入院となった。イレウス管造影で鼻腔より170 cmで小腸狭窄があり,腸閉塞解除術を施行した。Treitz靱帯より80 cm,100 cmと150 cmの小腸漿膜側で小腸を巻き込む腹壁と癒着した結節を認め,腹壁結節を含めて小腸切除と再建を行った。病理組織学的結果では腹壁結節内に3 mm程度の癌組織が認められ,腹膜播種による癒着性腸閉塞と診断した。切除可能な腹膜播種単発再発例は根治切除により,予後延長効果が期待できると考えられた。