Abstract
A 53-year-old woman who was traveling in Australia was admitted to a local hospital with pyrexia and diarrhea. Megacolon was diagnosed from an X-ray and an emergency operation was performed. However, the cause of megacolon was not clear, and the attempted operation ended in a simple laparotomy. Sigmoid cancer was found 3 weeks after the first operation and a colostomy was performed at the ascending colon. After the second operation, she returned to Japan and was thereafter admitted to our hospital. Total colonoscopy before the third surgery (sigmoidectomy) revealed erosive mucosa but no tumor. The damaged mucosa in the proximal colon (compatible with a diagnosis of obstructive colitis) was found during a sigmoidectomy. Watery diarrhea and melena persisted after the third operation. Colonoscopy showed disseminated tumor nodules at the proximal colon of the anastomosis at 37 days after the third surgery. Finally, a subtotal colectomy and jejunal pouch reconstruction were carried out. The exfoliated malignant cells from the sigmoid colon appeared to form micrometastases in the mucosal sites damaged by obstructive colitis. In conclusion, in a case of obstructive colitis due to cancer, we must consider the possibility that the tumor may spread to damaged mucosal sites and grow intraluminally.
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Kouraklis G, Glinavou A, Kouvaraki M, Raftopoulos J, Karatzas G. Anal lesion resulting from implantation of viable tumour cells in a pre-existing anal fistula. A case report. Acta Chir Belg 2002;102(3):212–213.
Shuto T, Tsukamoto T, Ohta Y, Takemura M, Ikebe T, Kinoshita H. Anastomotic recurrence due to tumor implantation using the double stapling technique. Hepatogastroenterology 1999;46(28): 2521–2522.
Papaziogas B, Koutelidakis G, Chatzimavroudis G, Tsiaousis P, Atmatzidis K. Intraluminal metastasis at the colostomy site after Hartmann’s procedure for obstructive rectal cancer. Tech Coloproctol 2006;10(4):365–366.
Cole WH. Measures to combat the menace of cancer. Am Surg 1951;17(7):660–663.
Vink M. Local recurrence of cancer in the large bowel: the role of implantation metastases and bowel disinfection. Br J Surg 1954;41(168):431–433.
Basha G, Ectors N, Penninckx F, Filez L, Geboes K. Tumor cell implantation after colonoscopy with biopsies in a patient with rectal cancer: report of a case. Dis Colon Rectum 1997;40(12): 1508–1510.
Tietjen GW, Markowitz AM. Colitis proximal to obstructing colonic carcinoma. Arch Surg 1975;110(9):1133–1138.
Gratama S, Smedts F, Whitehead R. Obstructive colitis: an analysis of 50 cases and a review of the literature. Pathology 1995; 27(4):324–329.
Toner M, Condell D, O’Briain DS. Obstructive colitis. Ulceroinflammatory lesions occurring proximal to colonic obstruction. Am J Surg Pathol 1990;14(8):719–728.
Levine TS, Price AB. Obstructive enterocolitis: a clinicopathological discussion. Histopathology 1994;25(1):57–64.
McGrew EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon. J Am Med Assoc 1954;154(15):1251–1254.
Umpleby HC, Fermor B, Symes MO, Williamson RC. Viability of exfoliated colorectal carcinoma cells. Br J Surg 1984;71(9): 659–663.
Broyn T. Tumour implantation in ischemic, thermic and mechanical lesions of the colonic mucosa. An experimental study in rats. Acta Chir Scand 1972;138(2):202–206.
Hubens G, Lafullarde T, Van ME, Vermeulen P, Hubens A. Implantation of colon cancer cells on intact and damaged colon mucosa and serosa: an experimental study in the rat. Acta Chir Belg 1994;94(5):258–262.
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Mekata, E., Shimizu, T., Endo, Y. et al. The rapid growth of intraluminal tumor metastases at the intestinal wall sites damaged by obstructive colitis due to sigmoid colon cancer: Report of a case. Surg Today 38, 862–865 (2008). https://doi.org/10.1007/s00595-007-3708-0
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DOI: https://doi.org/10.1007/s00595-007-3708-0