Buchs N C, Bloemendaal A L A, Guy R J
Churchill Hospital, University Hospitals of Oxford , Oxford , UK.
Ann R Coll Surg Engl. 2016 Mar;98(3):e52-4. doi: 10.1308/rcsann.2016.0092.
Perforated colonic cancers are not rare and leave patients at risk of developing peritoneal carcinomatosis. We present a 68-year-old male patient with a perforated transverse colonic tumour who underwent emergency extended right hemicolectomy. He made an uneventful postoperative recovery, and received adjuvant chemotherapy. Unfortunately, a routine positron emission tomography-computed tomography scan 16 months later demonstrated an fluorodeoxyglucose-avid nodule in the left scrotum associated with an irreducible left inguinal hernia that contained sigmoid colon. At laparotomy, the discovery of isolated peritoneal recurrence in the hernia sac was unexpected, given the absence of local recurrence in the region of the original transverse colon cancer perforation. The etiology therefore remains uncertain, but one may speculate that cell implantation occurred within the hernia sac at the initial emergency laparotomy.
穿孔性结肠癌并不罕见，会使患者面临发生腹膜癌病的风险。我们报告一名68岁男性患者，患有穿孔性横结肠肿瘤，接受了急诊扩大右半结肠切除术。他术后恢复顺利，并接受了辅助化疗。不幸的是，16个月后的常规正电子发射断层扫描-计算机断层扫描显示左阴囊有一个氟脱氧葡萄糖摄取阳性结节，伴有不可复性左腹股沟疝，疝内容物为乙状结肠。在剖腹手术中，鉴于原横结肠癌穿孔区域无局部复发，在疝囊内发现孤立性腹膜复发出乎意料。因此，病因仍不确定，但有人推测在最初的急诊剖腹手术时细胞已植入疝囊内。
