皮下気腫を来した上行結腸癌の腹壁穿破の1例

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  • A PATIENT WITH SUBCUTANEOUS EMPHYSEMA DUE TO ABDOMINAL WALL PENETRATION BY A CANCER OF THE ASCENDING COLON

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We often encounter patients with perforation by colonic cancer. Perforation into the peritoneal cavity is frequencly observed in the colon on the lfet side and produces symptoms of peritonitis. However, colorectal intestinal cancer penetrating into the s abdominal wall, forming an abdominal wall abscess and subcutaneous emphysema is rare. We experinced a patient with cancer of the ascending colon that caused subcutaneous emphysema. A 75-year-old male was seen at the hospital because of nausea and fever. Plain abdominal X-ray examination showed subcutaneous emphysema in the right lower abdomen. CT, barium enema, sa nd colonoscopy suggested subcutaneous emphysema due to direct infiltration into the abdominal wall of a cancer in the ascending colon. Surgical resection of the tumor was attempted, but was abandoned due to a poor systemic condition of teh patient, and firm and extensive infiltration of the tumor. Anastomosis between the ileum and transverse colon was performed. Postoperative administration of antibiotics improved the abdominal wall abscess and subcutaneous emphysema. He was discharged from the hospital. There have been 9 case reports of subcutaneous emphysema due to colonic cancer. In case of digestive tract penetration to the abdominal wall, the peritoneal irritation sign or intraperitoneal free gass is rarely observed. In abdominal wall acompained by subcutaneous emphysema, infection with gas gangrene bacteria tends to be suspected, but perforation or penetration of colonic cancer into the abdominal wall should be also considered in aged patients.

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