Wakasugi Masaki, Kono Hiroshi, Yasuhara Yumiko, Tsujimura Naoto, Nakahara Yujiro, Matsumoto Takashi, Takemoto Hiroyoshi, Takachi Ko, Nishioka Kiyonori, Yoshida Kyotaro, Oshima Satoshi
Department of Surgery, Kinki Central Hospital, 3-1 Kurumaduka, Itami, Hyogo 664-8533, Japan.
Department of Pathology, Kinki Central Hospital, 3-1 Kurumaduka, Itami, Hyogo 664-8533, Japan.
Int J Surg Case Rep. 2017 Nov 21;41:456-460. doi: 10.1016/j.ijscr.2017.11.027. eCollection 2017.
Medullary carcinoma is a rare type of colorectal adenocarcinoma, and omental infarction is a rare cause of acute abdomen.
A 72-year-old woman underwent single-incision laparoscopic right hemicolectomy for ascending colon cancer. Pathological examination showed a medullary carcinoma (MC) of T4aN0M0 Stage IIB. Her postoperative course was uneventful, and she was discharged on postoperative day (POD) 6. From POD 7, she suffered from fever, and she returned to the hospital on POD 9. Plain computed tomography showed free air beside the anastomotic site around the elevated density of fat tissue and gallbladder wall thickening with a gallstone. Suspecting anastomotic leakage with acute cholecystitis, probe laparotomy was performed. Intraoperative observation confirmed omental infarction with acute cholecystitis, and no leakage was found at the anastomotic site. Therefore, the necrotic part of the greater omentum was resected, and cholecystectomy was performed. She has remained well, with no evidence of recurrent cancer during the 12 months of follow-up without chemotherapy after the surgery for MC of the ascending colon.
MC should be distinguished from other more aggressive, non-glandular tumors of the colon because MC appears to have a better survival outcome than undifferentiated colon adenocarcinoma. Omental infarction should be considered in the differential diagnosis of acute abdomen after surgery.
A rare case of medullary carcinoma of the ascending colon followed by infarction of the greater omentum mimicking anastomotic leakage is presented.
髓样癌是一种罕见的结直肠腺癌类型，而大网膜梗死是急腹症的罕见病因。
一名72岁女性因升结肠癌接受了单孔腹腔镜右半结肠切除术。病理检查显示为T4aN0M0 IIB期髓样癌（MC）。她的术后过程顺利，术后第6天出院。从术后第7天起，她出现发热，术后第9天返回医院。普通计算机断层扫描显示吻合口旁有游离气体，周围脂肪组织密度升高，胆囊壁增厚并伴有胆结石。怀疑吻合口漏合并急性胆囊炎，遂行探查性剖腹手术。术中观察证实为大网膜梗死合并急性胆囊炎，吻合口未发现漏。因此，切除了大网膜坏死部分，并进行了胆囊切除术。术后12个月随访期间，她恢复良好，未接受化疗，无升结肠MC复发迹象。
MC应与结肠其他侵袭性更强的非腺性肿瘤相鉴别，因为MC的生存结果似乎优于未分化结肠腺癌。术后急腹症的鉴别诊断应考虑大网膜梗死。
本文报告了一例罕见的升结肠髓样癌继发大网膜梗死，酷似吻合口漏的病例。
