Tarik I A, Henry F J, Shabery N A, Omar Z, Ibrahim O E
Naluri Hospital, General Surgical Department, Kuala Lumpur, Malaysia.
Hospital Selayang, General Surgical Department, Malaysia.
Med J Malaysia. 2022 Mar;77(2):258-260.
We report a case of a 41-year-old pregnant woman who initially presented with a sub-umbilical lump, for nearly five months. Subsequently, an ultrasound study was performed, and the patient underwent a surgical drainage operation for a presumed inflammatory condition, at the periumbilical region. The patient returned after a week post-drainage with a faecal discharging fistula. One month later, the patient had an emergency lower caesarean section plus bilateral tubal ligation because of the transverse lie of the foetus. Onemonth post-operative caesarean section, the fistula opening showed a big protruding ulcerating mass. En-bloc resection of the transverse and the descending colon was performed, and the histopathologic diagnosis showed a moderately differentiated mucinous adenocarcinoma. This case highlights that a high index of suspicion was recommended in an unresolved periumbilical lump (pseudo Sister Mary Joseph's nodule), and periumbilical metastasis of colorectal cancer frequently indicates advanced disease and poor prognosis. In view of its rarity of occurrence and limited experience, in the management of an ambiguous case, we report this case.
我们报告一例41岁的孕妇,她最初出现脐下肿块近五个月。随后进行了超声检查,患者因脐周疑似炎症性病变接受了手术引流。引流术后一周患者因粪瘘再次就诊。一个月后,由于胎儿横位,患者接受了急诊低位剖宫产加双侧输卵管结扎术。剖宫产术后一个月,瘘口处出现一个巨大突出的溃疡性肿块。进行了横结肠和降结肠的整块切除,组织病理学诊断为中分化黏液腺癌。该病例强调,对于未明确诊断的脐周肿块(假性玛丽·约瑟夫修女结节),应高度怀疑,结直肠癌的脐周转移常提示疾病晚期且预后不良。鉴于其发病率低且经验有限,在处理疑难病例时,我们报告了此病例。