肝膿瘍を合併しFDG-PETで診断された横行結腸癌の1例 [in Japanese] A CASE OF COLON CANCER WITH A LIVER ABSCESS DIAGNOSED BY FDG-PET [in Japanese]
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症例は81歳の女性.発熱,倦怠感を主訴に当院循環器科を受診し入院となった.腹部超音波にて肝腫瘤を指摘,当科紹介された.入院時体温38.3°C.腹部造影CTにて肝右葉に周囲が造影される孤立性の腫瘤を認め,肝膿瘍と診断したが転移性肝腫瘍の可能性も考えFDG-PETを施行したところ,肝腫瘤部と左上腹部に異常集積を認めた.注腸で脾彎曲部に狭窄像と, CTで横行結腸の壁肥厚像を認めた.抗生剤投与により解熱しCTで肝腫瘤の縮小を認め, FDG-PETで肝臓の異常集積は消失した.以上より肝膿瘍を合併した大腸癌と診断し,開腹手術を施行.脾彎曲部の横行結腸癌に対して横行結腸切除術を施行.その後肝膿瘍は完全に消失し,肝膿瘍と癌再発は認めていない.<br> 肝膿瘍を契機にFDG-PETで診断された,肝膿瘍を合併した横行結腸癌の1例を経験したので,若干の考察を加え報告する.
An 81-year-old woman admitted to the department of internal medicine in our hospital because of fever and general fatigue was found having a liver tumor and referred to the department of surgery. The body temperature on admission was 38.3°C. Enhanced CT scan of the abdomen visualized a solitary tumor with enhanced periphery in the right lobe of liver. Liver abscess was diagnosed, however, a possibility of metastatic liver tumor could not be ruled out so that FDG-PET was carried out. It showed abnormal accumulation in the liver tumor as well as left upper abdomen. Barium enema study showed a narrowing portion at the splenic flexure. CT scan revealed wall thickening of the transverse colon. Following administration of antibiotics her fever decreased and the liver tumor diminished in size. FDG-PET showed disappearance of the abnormal accumulation in the liver tumor. From these findings, colonic cancer associated with liver abscess was diagnosed and laparotomy was performed. Transverse colectomy was employed for transverse colon cancer at the splenic flexure. Thereafter the liver abscess completely disappeared, and no liver abscess and colonic cancer have recurred.<br> In this paper we present this case of transverse colon cancer with liver abscess which presented with liver abscess and was diagnosed by FDG-PET, together with a review of the literature.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(4), 838-842, 2006-04-25
Japan Surgical Association