Kasuga So, Abe Shinya, Nozawa Hiroaki, Sasaki Kazuhito, Murono Koji, Emoto Shigenobu, Matsuzaki Hiroyuki, Yokoyama Yuichiro, Nagai Yuzo, Yoshioka Yuichiro, Shinagawa Takahide, Sonoda Hirofumi, Ushiku Tetsuo, Ishihara Soichiro
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
Department of Pathology, The University of Tokyo, Tokyo, Japan.
J Surg Case Rep. 2023 Apr 12;2023(4):rjad179. doi: 10.1093/jscr/rjad179. eCollection 2023 Apr.
A 71-year-old man was diagnosed with advanced non-small cell lung carcinoma and treated with chemotherapy developed ileocecal diverticulitis three times over the last 2 months of receiving second-line treatment. During the fourth diverticulitis event, the patient presented with fever and abdominal pain, worsening after 5 days. Abdominal computed tomography showed ascites and intra-abdominal free air, suggesting bowel perforation with acute diffuse peritonitis. We performed emergency surgery; the surgical findings showed diverticulosis with perforated diverticula in the ileocecal region. We performed ileocecal resection, an ileostomy and a mucous fistula of the ascending colon. Histopathological examinations revealed pseudodiverticula at the perforation, where the mucosa was depressed through the muscularis propria. Hence, we diagnosed perforated ileal diverticulitis. Repeated diverticulitis triggered by chemotherapy might have resulted in perforation. Small bowel diverticula are rare, but diverticulitis can occur in patients receiving chemotherapy and with cases of unexplained fever and abdominal pain.
一名71岁男性被诊断为晚期非小细胞肺癌并接受化疗，在接受二线治疗的最后2个月内3次发生回盲部憩室炎。在第四次憩室炎发作时，患者出现发热和腹痛，5天后病情加重。腹部计算机断层扫描显示腹水和腹腔内游离气体，提示肠穿孔伴急性弥漫性腹膜炎。我们进行了急诊手术；手术结果显示回盲部有憩室病，回盲部憩室穿孔。我们进行了回盲部切除术、回肠造口术和升结肠黏液瘘。组织病理学检查显示穿孔处为假性憩室，黏膜通过固有肌层凹陷。因此，我们诊断为穿孔性回肠憩室炎。化疗引发的反复憩室炎可能导致了穿孔。小肠憩室很少见，但憩室炎可发生在接受化疗的患者以及出现不明原因发热和腹痛的病例中。
