Kinoshita Jun, Fushida Sachio, Tsukada Tomoya, Oyama Katsunobu, Watanabe Toshifumi, Okamoto Koichi, Makino Isamu, Nakamura Keishi, Hayashi Hironori, Nakagawara Hisatoshi, Miyashita Tomoharu, Tajima Hidehiro, Takamura Hiroyuki, Ninomiya Itasu, Kitagawa Hirohisa, Fujimura Takashi, Ohta Tetsuo
Department of Gastroenterologic Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
World J Surg Oncol. 2014 Jun 4;12:177. doi: 10.1186/1477-7819-12-177.
Intraperitoneal (i.p.) chemotherapy is garnering attention as an effective treatment for gastric cancer with peritoneal metastasis. We report the case of a patient who developed colonic stenosis caused by infection of an i.p. access port system during i.p. chemotherapy. It was difficult to differentiate whether the extrinsic colonic stenosis arose from a catheter infection or peritoneal metastasis of the gastric cancer.
A 66-year-old Japanese man underwent total gastrectomy for gastric cancer. Because the intraoperative findings revealed peritoneal metastasis, a port system was implanted for subsequent i.p. chemotherapy. Two months after initiation of chemotherapy, he complained of vomiting and abdominal pain. A computed tomography scan revealed marked thickening of the sigmoid colon wall adjacent to the catheter of the i.p. access port system. A barium enema demonstrated extrinsic irregular stenosis of the sigmoid colon. Although it was difficult to distinguish whether infection or peritoneal metastasis had caused the colonic stenosis, we removed the port system to obtain a therapeutic diagnosis. Coagulase-negative staphylococci were detected by catheter culture. The wall thickening and stenosis of the sigmoid colon completely resolved after removal of the port system.
We report the case of a rare complication in association with an i.p. access port system. Infection of the port system should be considered as a differential diagnosis when colonic stenosis adjacent to the catheter is observed during i.p. chemotherapy.
腹腔内化疗作为治疗伴有腹膜转移的胃癌的一种有效方法正受到关注。我们报告了一例在腹腔内化疗期间因腹腔置入端口系统感染导致结肠狭窄的患者病例。很难区分结肠外源性狭窄是由导管感染还是胃癌腹膜转移引起的。
一名66岁的日本男性因胃癌接受了全胃切除术。由于术中发现有腹膜转移，植入了端口系统以便后续进行腹腔内化疗。化疗开始两个月后，他出现呕吐和腹痛。计算机断层扫描显示腹腔置入端口系统导管附近的乙状结肠壁明显增厚。钡灌肠显示乙状结肠有外源性不规则狭窄。尽管很难区分是感染还是腹膜转移导致了结肠狭窄，但我们移除了端口系统以进行治疗性诊断。导管培养检测到凝固酶阴性葡萄球菌。移除端口系统后，乙状结肠壁增厚和狭窄完全缓解。
我们报告了一例与腹腔置入端口系统相关的罕见并发症病例。在腹腔内化疗期间观察到导管附近结肠狭窄时，应考虑端口系统感染作为鉴别诊断。
