Machida Tomohiko, Tanaka Junichi, Terashima Takeshi
Dept. of Surgery, Kano General Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):1683-5.
A 81-year-old woman confined to full bed rest due to the effects of a stroke 7 years prior, was brought to our hospital with acute cholecystitis in late April 2013. After PTGBD, her condition improved and she was discharged in early June. However, she was urgently hospitalized at the beginning of August with melena and a fever. A detailed examination revealed aspiration pneumonia, which was resolved with a course of antibiotics. A colonoscopy, conducted to find the cause of the melena, revealed a circumferential type 2 tumor in the ascending colon, and a fiberscope was unable to pass through the stenosis. A biopsy confirmed a diagnosis of signet-ring cell carcinoma. Using abdominal computed tomography, thickening of the ascending colon wall, suggesting infiltration to the periphery, was visible. The adjacent lymph nodes were enlarged, but there were no clear signs of liver metastasis. Cancerous peritonitis was suspected due to the presence of ascitic fluid. Considering the overall condition of the patient, surgery was not performed, and colonic stent was not placed due to the proximity of the stenosis to the ileocecal valve. The patient's family chose best supportive care. The patient's condition worsened and she died 3 months after leaving the hospital.
一名81岁女性，因7年前中风的影响而长期卧床，于2013年4月下旬因急性胆囊炎被送至我院。经皮经肝胆道引流术后，她的病情有所改善，并于6月初出院。然而，她在8月初因黑便和发热紧急住院。详细检查发现为吸入性肺炎，经一个疗程的抗生素治疗后痊愈。为找出黑便原因而进行的结肠镜检查显示，升结肠有一个2型环周肿瘤，纤维结肠镜无法通过狭窄部位。活检确诊为印戒细胞癌。腹部计算机断层扫描显示升结肠壁增厚，提示肿瘤已浸润至周围组织。相邻淋巴结肿大，但无明显肝转移迹象。因存在腹水，怀疑有癌性腹膜炎。考虑到患者的整体状况，未进行手术，且由于狭窄部位靠近回盲瓣，未放置结肠支架。患者家属选择了最佳支持治疗。患者病情恶化，出院3个月后死亡。
