多発横行結腸癌に起因した成人腸重積症の1例

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  • A Case of Adult Intussusception Caused by Multiple Cancer of the Transverse Colon

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We report a rare case of adult asymptomatic intussusception caused by transverse colon cancer and review the literature. A 74-year-old woman admitted to our hospital with edema of legs showed a tender hard mass in the right upper abdomen upon examination. Intussusception caused by transverse colon cancer was diagnosed based on barium enema, ultrasonography, computed tomography, and colonoscopy. She developed ileus during preoperative preparation of the colon and was managed conservatively. We conducted transeversecolectomy with D3 lymph node dissection. Upon laparotomy, the transverse colon was found to be normogradely invaginated with a tumor at the apex of the intussusception, with two lesions located closely side by side in the right side of the transverse colon. Histopathologically, one was poorly differentiated type 1 adenocarcinoma with n2 (+) and was 95 mm in diameter. The second lesion was moderately differentiated type 2 adenocarcinoma and 33 mm in diameter. Intussusception in adults is rarely caused by transverse colon cancer, with only 6 cases reported in Japan. All cases, including ours, involved elderly women and type 1 tumors. Five of 6 previously reported cases had ileus on admission. Precautions should thus be taken while preparing patients for investigations such as barium enema and for surgery to avoid iatrogenic ileus.

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