Kayano Hajime, Ueda Yusuhiko, Machida Takashi, Hiraiwa Shinichiro, Zakoji Hidenori, Tajiri Takuma, Mukai Masaya, Nomura Eiji
Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan.
Departments of Pathology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan.
World J Clin Cases. 2019 Jul 6;7(13):1643-1651. doi: 10.12998/wjcc.v7.i13.1643.
Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a colonic diverticulum. When colon cancer arises in a diverticulum and then tends to develop outside the wall, without developing within the lumen, the differential diagnosis from complicating lesions due to colonic diverticulitis is difficult.
A 76-year-old man was admitted to a nearby clinic with a chief complaint of discomfort and urinary frequency. Since a vesicosigmoidal fistula was seen on abdominal computed tomography, he was referred to our hospital. Laparoscopic sigmoidectomy was performed because the various diagnostic findings were diagnosed as a vesicosigmoidal fistula with diverticulitis of the sigmoid colon. However, on histopathological examination, it was diagnosed as a vesicosigmoidal fistula due to colon cancer arising in the diverticulum. Laparoscopic partial resection of the bladder was performed because local recurrence was observed in the bladder wall one and a half years after surgery. It is currently one year after reoperation, but there has been no recurrence or metastasis.
Colon cancer arising in a diverticulum of the colon should be considered when diverticulitis with complications is observed.
结肠憩室病是一种常见疾病，临床上结肠憩室病与结直肠癌并存的情况屡见不鲜。结肠癌起源于结肠憩室黏膜的情况极为罕见。当结肠癌在憩室内发生并倾向于向肠壁外发展，而非在肠腔内发展时，与结肠憩室炎所致并发症的鉴别诊断较为困难。
一名76岁男性因不适和尿频为主诉入住附近诊所。因腹部计算机断层扫描发现膀胱乙状结肠瘘，遂转诊至我院。由于各种诊断结果均诊断为膀胱乙状结肠瘘伴乙状结肠憩室炎，故行腹腔镜乙状结肠切除术。然而，组织病理学检查显示，该病例诊断为憩室内发生的结肠癌导致的膀胱乙状结肠瘘。术后一年半，因膀胱壁出现局部复发，遂行腹腔镜膀胱部分切除术。目前再次手术已过去一年，但未出现复发或转移。
当观察到伴有并发症的憩室炎时，应考虑结肠癌起源于结肠憩室的情况。
