AlAyoubi Alamir-Noureddine, Ghattas Souad, Maalouf Hani, Chahine Georges, Kiriakos Kiril, Fares Mirna
Department of Internal Medicine, Pulmonary Medicine and Critical Care Medicine, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon.
Department of General Surgery, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon.
Surg J (N Y). 2024 Dec 20;10(4):e65-e70. doi: 10.1055/s-0044-1800978. eCollection 2024 Oct.
Colonic obstruction is reported in 85% of emergency colorectal surgery for cancer. Colonic ischemia, however, is a rare entity and is found in 5% of these emergency cases. We herein present the case of a 72-year-old man presenting with signs and symptoms of obstruction and was found to have an obstructive sigmoid cancer. A first urgent laparotomy showed small bowel ischemia, for which small bowel resection and large bowel decompression were done without tumor resection. Postoperatively, the patient transiently improved, then deteriorated in few days, and a second urgent laparotomy showed a large bowel ischemia proximal to the mass. The treatment for patients with colon cancer with suspected colonic ischemia should be emergency laparotomy with long abdominal incision, carefully exploring the whole length of the small and large bowel. Despite large bowel decompression, a secondary colonic ischemic event should be suspected in case of deterioration.
在因癌症进行的急诊结直肠手术中，85%的病例报告有结肠梗阻。然而，结肠缺血是一种罕见情况，在这些急诊病例中占5%。我们在此报告一例72岁男性病例，该患者表现出梗阻的体征和症状，被发现患有梗阻性乙状结肠癌。首次急诊剖腹探查显示小肠缺血，为此进行了小肠切除和大肠减压，但未进行肿瘤切除。术后，患者短暂好转，但几天后病情恶化，第二次急诊剖腹探查显示肿块近端大肠缺血。对于怀疑有结肠缺血的结肠癌患者，治疗应采用腹部长切口的急诊剖腹探查，仔细探查小肠和大肠的全长。尽管进行了大肠减压，但如果病情恶化，应怀疑继发性结肠缺血事件。
