Le David P
Internal Medicine, University of South Alabama, Mobile, USA.
Cureus. 2023 Jul 6;15(7):e41469. doi: 10.7759/cureus.41469. eCollection 2023 Jul.
A 37-year-old male presented multiple times for abdominal pain with a persistent diverticular abscess on imaging that was managed previously with antibiotics and percutaneous drainages. Due to unrelenting abdominal pain and multiple presentations of unresolved acute complicated diverticulitis, the patient underwent an exploratory laparotomy. A colonic mass was discovered, and the patient had a colonic resection. Pathology revealed invasive transverse colonic adenocarcinoma with perforation and involvement of the stomach. Imaging showed no distant metastatic disease and chemotherapy was started. Months after treatment, the patient developed skin lesions and a palpable mass at the previous drain site. Biopsy showed metastatic adenocarcinoma consistent with colonic origin. Colonic adenocarcinoma with metastasis to the abdominal wall after drainage of presumed diverticular abscess is rare. Clinicians should consider malignancy when a patient has a recurrent diverticular abscess that has failed medical management and multiple drainages. Clinicians should remain vigilant of the risk of seeding colonic adenocarcinoma to the abdominal wall when repeated drainage is performed.
一名37岁男性因腹痛多次就诊，影像学检查显示存在持续性憩室脓肿，此前接受过抗生素治疗和经皮引流。由于腹痛持续不缓解且多次出现未解决的急性复杂性憩室炎，患者接受了剖腹探查术。术中发现一个结肠肿物，遂行结肠切除术。病理显示为浸润性横结肠癌，伴有穿孔及胃受累。影像学检查未发现远处转移病灶，于是开始化疗。治疗数月后，患者在先前引流部位出现皮肤病变及可触及的肿物。活检显示为转移性腺癌，与结肠来源相符。推测为憩室脓肿引流后发生腹壁转移的结肠腺癌很罕见。当患者复发性憩室脓肿经药物治疗及多次引流均失败时，临床医生应考虑恶性肿瘤的可能。当进行反复引流时，临床医生应警惕结肠腺癌种植至腹壁的风险。
