Murakami Masakazu, Miyake Yasuhiro, Uemura Hisashi, Okada Kaoru, Nakane Shigeru, Higaki Naozumi, Hayashida Hirohito, Oka Yoshio, Nezu Riichiro
Dept. of Surgery, Nishinomiya Municipal Central Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):1654-6.
We describe the case of a patient with sigmoid colon cancer liver metastasis accompanied by multiple liver abscesses. The 59-year-old female patient presented with a fever at a body temperature of 39.0°C. On abdominal computed tomography (CT), multiple liver abscesses were detected, and percutaneous transhepatic abscess drainage (PTAD) was performed. The day after the PTAD, the patient's fever subsided and her inflammatory response abated. A lower gastrointestinal examination, performed to identify the origin of her symptoms, revealed a type 1 tumor in the sigmoid colon. A biopsy indicated a moderately differentiated adenocarcinoma. Prior to surgery, a second abdominal CT scan was performed, and a single liver metastasis was detected. Laparoscopic sigmoidectomy and partial liver resection were simultaneously performed. The histopathological diagnosis of the colon cancer was tub2, pN1, pH1, P0, ly1, v1, stage IV. To date, the patient remains free from hepatic abscess and colon cancer recurrence. Gastrointestinal examinations should be performed as early as possible to identify the cause of hepatic abscesses. Moreover, therapeutic decisions should only be made after imaging and examinations have been performed, which will be sufficient to identify the presence of liver metastases.
我们描述了一例患有乙状结肠癌肝转移并伴有多个肝脓肿的患者的病例。这位59岁的女性患者出现发热，体温为39.0°C。腹部计算机断层扫描（CT）显示多个肝脓肿，遂进行经皮肝脓肿引流术（PTAD）。PTAD术后第二天，患者体温下降，炎症反应减轻。为确定症状来源进行的下消化道检查发现乙状结肠有1型肿瘤。活检显示为中分化腺癌。手术前，再次进行腹部CT扫描，发现一处肝转移。同时进行了腹腔镜乙状结肠切除术和部分肝切除术。结肠癌的组织病理学诊断为tub2、pN1、pH1、P0、ly1、v1，IV期。迄今为止，该患者未出现肝脓肿和结肠癌复发。应尽早进行胃肠道检查以确定肝脓肿的病因。此外，只有在进行影像学检查和各项检查足以确定肝转移存在之后，才能做出治疗决策。
