化学療法中に小腸穿孔をきたしたIV期肺癌の1例 A CASE OF PERFORATION INTRACHEMOTHERAPY FOR STAGE IV LUNG CANCER

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症例は72歳,男性.咳嗽・右鼠径部膨隆を主訴に来院.右鼠径ヘルニアの診断にて根治術施行時に認めた腹水の細胞診から非小細胞癌が検出され,癌性腹膜炎と判明した.精査にて左肺を原発とするStageIVの非小細胞肺癌と診断された.カルボプラチンおよびパクリタキセルの化学療法を1コース施行し,原発巣は縮小したが,11日目から腹痛が出現し腹部X線にてfree airを認め,消化管穿孔による汎発性腹膜炎を疑い同日開腹手術を施行した.上部空腸にφ3×2cm大の転移巣を認め,その中心が壊死・穿孔していた.他にも3箇所小腸転移巣を認め,その転移巣も含めた小腸部分切除術を施行した.術後に化学療法再開予定であったが,肺病変の進行により全身状態が増悪して18病日に死亡した.肺癌の小腸転移例はしばしば認められるが穿孔例は少ない.腹腔内転移を伴う肺癌の治療中は,消化管穿孔の可能性を念頭において慎重に経過観察する必要がある.

A 72-year-old man visited our hospital because of cough and right inguinal swelling was performed radical operation with a diagnosis of right inguinal hernia, when ascites was identified. The cytologic diagnosis of the ascites was non-small cell carcinoma and peritonitis carcinomatosa was clarified. Following close exploration, Stage IV non-small cell carcinoma of the left lung was diagnosed. One course of chemotherapy with carboplatin and paclitaxel yielded a decrease of the primary lesion in size. However, abdominal pain developed on the 11<SUP>th</SUP> day after the regimen and an abdominal x-ray film showed free air. General peritonitis due to perforation of the digestive tract was suggested and laparotomy was performed on the same day. A 3 × 2cm metastatic lesion was confirmed in the upper portion of the jejunum, of which center part became necrotic and perforated. Three other metastatic lesions were present in the small intestine. Partial resection of the small intestine including all lesions was performed. The chemotherapy was scheduled to resume after the operation, however, the pulmonary lesion progressed, the patient's general condition deteriorated, and the patient died on the 18<SUP>th</SUP> hospital day. <BR>Cases of lung cancer metastasized to the small intestine are often encountered, but such cases causing perforation are rare. Careful observation of clinical course would be mandatory during treatment of lung cancer associated with intra-abdominal metastasis by keeping a possibility of gastrointestinal perforation in mind.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 69(7), 1651-1654, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944540
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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