Ding Haibo, Xu Baiying, Wang Yueming, Xu Bin, Qiu Wei, Zhang Wenzhong, Wang Yongbing, Li Gang
Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China.
Ann Med Surg (Lond). 2024 Aug 1;86(9):5604-5610. doi: 10.1097/MS9.0000000000002425. eCollection 2024 Sep.
Colon cancer presenting as a large abdominal mass accompanied by abscess and rupture is rare and prone to be misdiagnosed and delayed. In addition, the treatment plan is not clear when combined with abdominal wall metastasis.
A 79-year-old woman presented with a large abdominal mass accompanied by abscess and rupture. It was misdiagnosed as a soft tissue infection in a local hospital, and after a comprehensive examination, it was diagnosed as sigmoid colon cancer with abdominal wall metastasis and abscess formation. The patient underwent a one-stage surgery, including en bloc resection of the tumor and invaded abdominal wall, as well as autologous tissue abdominal wall reconstruction, with a good clinical prognosis.
For the diagnosis of large abdominal masses, abdominal CT, and pus culture are more valuable than ultrasound. For colon cancer with abdominal wall metastasis, one-stage surgery to completely remove the tumor and full-thickness of the abdominal wall, and the use of autologous tissue abdominal wall reconstruction technology to repair defects is feasible.
This case highlights the importance of using colon cancer as one of the differential diagnoses for the diagnosis for large abdominal mass accompanied by abscess and rupture in elderly patients, as well as the possibility of one-stage surgical resection of the tumor and invasion of the abdominal wall and reconstruction of the abdominal wall with autologous tissue when there is abdominal wall metastasis.
以巨大腹部肿块伴脓肿及破裂为表现的结肠癌较为罕见,容易被误诊和延误诊断。此外,合并腹壁转移时治疗方案尚不明确。
一名79岁女性患者,表现为巨大腹部肿块伴脓肿及破裂。在当地医院被误诊为软组织感染,经过全面检查后,诊断为乙状结肠癌伴腹壁转移及脓肿形成。患者接受了一期手术,包括肿瘤及受累腹壁的整块切除,以及自体组织腹壁重建,临床预后良好。
对于巨大腹部肿块的诊断,腹部CT和脓液培养比超声更有价值。对于伴有腹壁转移的结肠癌,一期手术完全切除肿瘤及腹壁全层,并采用自体组织腹壁重建技术修复缺损是可行的。
本病例强调了将结肠癌作为老年患者巨大腹部肿块伴脓肿及破裂诊断的鉴别诊断之一的重要性,以及当存在腹壁转移时,肿瘤及腹壁受累进行一期手术切除并采用自体组织重建腹壁的可能性。