Girão de Caires Francisco, Nunes Mafalda, Flores Priscila, Girão de Caires António, Dionísio Isabel
General Surgery, Centro Hospitalar do Oeste, Caldas da Rainha, PRT.
Intensive Care Unit, Centro Hospitalar Médio Tejo, Abrantes, PRT.
Cureus. 2024 Jul 8;16(7):e64056. doi: 10.7759/cureus.64056. eCollection 2024 Jul.
Bowel obstructions are one of the main causes of hospital admissions for acute abdominal pain. In addition, bladder cancer is one of the most common cancers in the world. This said, bowel obstruction and bladder cancer are very frequent diseases but the same cannot be said about the association between these two pathologies. We report a unique case of an 80-year-old patient admitted to the emergency room with a bowel obstruction caused by a urothelial carcinoma with adrenal metastasis. The patient underwent an urgent laparotomy, and intraoperative inspection of the peritoneal cavity confirmed a large tumorous mass suspected of gastrointestinal etiology. The mass infiltrated the ileum and sigmoid colon and was apparently in contact with the bladder wall. An en-bloc resection of the lesion was performed. An R0 excison was not possible and fragments of the lesion were excised from the bladder wall for separate analysis. Histopathological examination of the resected specimen described a high-grade, undifferentiated urothelial carcinoma that originated in the bladder and invaded the ileum and sigmoid colon. The presence of an invasive urothelial carcinoma presenting with bowel obstruction represents an unexpected diagnosis and, although rare, the surgeon must be aware of this possibility. This case should serve as a reminder that a broad differential diagnosis should be considered when investigating an abdominal tumor.
肠梗阻是急性腹痛患者住院的主要原因之一。此外，膀胱癌是世界上最常见的癌症之一。也就是说，肠梗阻和膀胱癌都是常见疾病，但这两种病症之间的关联并非如此。我们报告了一例独特病例，一名80岁患者因尿路上皮癌伴肾上腺转移导致肠梗阻而入住急诊室。患者接受了紧急剖腹手术，术中对腹腔进行检查，确认有一个疑似胃肠道病因的巨大肿瘤块。该肿块浸润回肠和乙状结肠，且明显与膀胱壁接触。对病变进行了整块切除。无法进行R0切除，从膀胱壁切除病变碎片进行单独分析。切除标本的组织病理学检查显示为高级别、未分化的尿路上皮癌，起源于膀胱并侵犯回肠和乙状结肠。出现肠梗阻的浸润性尿路上皮癌是一种意外诊断，虽然罕见，但外科医生必须意识到这种可能性。这个病例应提醒人们，在调查腹部肿瘤时应考虑广泛的鉴别诊断。
