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Cecal perforation with an ascending colon cancer caused by upper gastrointestinal endoscopy.

Miyatani H, Yoshida Y, Kiyozaki H - Ther Clin Risk Manag (2009)

Bottom Line: Because her symptoms improved, upper GI endoscopy was performed 11 days later.Seven months postoperatively, the patient died of lung, liver, and brain metastases.Even in cases with a lesion that is not completely obstructed, it is important to note that air insufflations during upper GI endoscopy can perforate the intestinal wall in patients with advanced colon cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, Japan;

ABSTRACT
Colonic perforation caused by upper gastrointestinal (GI) endoscopy is extremely rare. A 69-year-old woman was referred to our hospital because of abdominal fullness. Colonoscopy could be performed only up to the hepatic flexure due to an elongated colon and residual stools. Because her symptoms improved, upper GI endoscopy was performed 11 days later. The patient developed severe abdominal pain two hours after the examination. Abdominal X-ray and computed tomography showed massive free air. Immediate laparotomy was performed for the intestinal perforation. After removal of stool, a perforation site was detected in the cecum with an invasive ascending colon cancer. Therefore, a right hemicolectomy, ileostomy, and transverse colostomy were performed. Although she developed postoperative septicemia, the patient was discharged 38 days after admission. Seven months postoperatively, the patient died of lung, liver, and brain metastases. Even in cases with a lesion that is not completely obstructed, it is important to note that air insufflations during upper GI endoscopy can perforate the intestinal wall in patients with advanced colon cancer.

No MeSH data available.


Related in: MedlinePlus

Gross appearance of the resected colon and small intestine. Advanced ascending colon cancer (arrow) and cecal perforation site (arrow head) were found.
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f2-tcrm-5-301: Gross appearance of the resected colon and small intestine. Advanced ascending colon cancer (arrow) and cecal perforation site (arrow head) were found.

Mentions: A 69-year-old woman was referred because of abdominal fullness. She complained of intermittent nausea and had vomited for two months. She had no weight loss, hematochezia, and melena. There were no temporal relationship between meals and her symptom. She had normal bowel movements and no abdominal pain. On physical examination, the patient appeared to be in no acute distress. Her abdomen was slightly distended without tenderness or a mass. An abdominal X-ray showed a large amount of stool in the colon (Figure 1). The serum carcinoembryonic antigen (CEA) (7.3 ng/ml) was slightly elevated. Other laboratory data were normal. Colonoscopy was performed after a retention enema. Unfortunately endoscopic examination could be performed only up to the hepatic flexure due to an elongated colon and residual stools. No abnormal lesion was found. Because of her symptomatic improvement and low probability of colonic obstruction, screening upper GI endoscopy was performed to find the cause of vomiting 11 days later. The upper GI endoscopy revealed mild gastropathy and a small benign-appearing polyp without abnormal findings in the duodenum. Endoscopic examination was routinely finished without biopsy. The patient developed severe abdominal pain two hours after the examination and returned. Her systolic blood pressure was 78 mmHg by palpation, her abdomen was diffusely distended, and bowel sounds were absent. Abdominal X-ray and computed tomography (CT) showed massive free air. Immediate laparotomy was performed for the intestinal perforation. There was a massive amount of stool in the abdominal cavity. After removal of the stool, a perforation site was detected in the cecum with an invasive near-circumferential ascending colon cancer (Figure 2). The perforation site was separated from the tumor. There was no evidence of metastasis except for direct invasion to the duodenal serosa which could be easily peeled. Therefore, a right hemicolectomy, ileostomy, and transverse colostomy were performed. Although she developed postoperative septicemia, the patient was discharged 38 days after admission. Seven months postoperatively, the patient died of lung, liver, and brain metastases.


Cecal perforation with an ascending colon cancer caused by upper gastrointestinal endoscopy.

Miyatani H, Yoshida Y, Kiyozaki H - Ther Clin Risk Manag (2009)

Gross appearance of the resected colon and small intestine. Advanced ascending colon cancer (arrow) and cecal perforation site (arrow head) were found.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697535&req=5

f2-tcrm-5-301: Gross appearance of the resected colon and small intestine. Advanced ascending colon cancer (arrow) and cecal perforation site (arrow head) were found.
Mentions: A 69-year-old woman was referred because of abdominal fullness. She complained of intermittent nausea and had vomited for two months. She had no weight loss, hematochezia, and melena. There were no temporal relationship between meals and her symptom. She had normal bowel movements and no abdominal pain. On physical examination, the patient appeared to be in no acute distress. Her abdomen was slightly distended without tenderness or a mass. An abdominal X-ray showed a large amount of stool in the colon (Figure 1). The serum carcinoembryonic antigen (CEA) (7.3 ng/ml) was slightly elevated. Other laboratory data were normal. Colonoscopy was performed after a retention enema. Unfortunately endoscopic examination could be performed only up to the hepatic flexure due to an elongated colon and residual stools. No abnormal lesion was found. Because of her symptomatic improvement and low probability of colonic obstruction, screening upper GI endoscopy was performed to find the cause of vomiting 11 days later. The upper GI endoscopy revealed mild gastropathy and a small benign-appearing polyp without abnormal findings in the duodenum. Endoscopic examination was routinely finished without biopsy. The patient developed severe abdominal pain two hours after the examination and returned. Her systolic blood pressure was 78 mmHg by palpation, her abdomen was diffusely distended, and bowel sounds were absent. Abdominal X-ray and computed tomography (CT) showed massive free air. Immediate laparotomy was performed for the intestinal perforation. There was a massive amount of stool in the abdominal cavity. After removal of the stool, a perforation site was detected in the cecum with an invasive near-circumferential ascending colon cancer (Figure 2). The perforation site was separated from the tumor. There was no evidence of metastasis except for direct invasion to the duodenal serosa which could be easily peeled. Therefore, a right hemicolectomy, ileostomy, and transverse colostomy were performed. Although she developed postoperative septicemia, the patient was discharged 38 days after admission. Seven months postoperatively, the patient died of lung, liver, and brain metastases.

Bottom Line: Because her symptoms improved, upper GI endoscopy was performed 11 days later.Seven months postoperatively, the patient died of lung, liver, and brain metastases.Even in cases with a lesion that is not completely obstructed, it is important to note that air insufflations during upper GI endoscopy can perforate the intestinal wall in patients with advanced colon cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, Japan;

ABSTRACT
Colonic perforation caused by upper gastrointestinal (GI) endoscopy is extremely rare. A 69-year-old woman was referred to our hospital because of abdominal fullness. Colonoscopy could be performed only up to the hepatic flexure due to an elongated colon and residual stools. Because her symptoms improved, upper GI endoscopy was performed 11 days later. The patient developed severe abdominal pain two hours after the examination. Abdominal X-ray and computed tomography showed massive free air. Immediate laparotomy was performed for the intestinal perforation. After removal of stool, a perforation site was detected in the cecum with an invasive ascending colon cancer. Therefore, a right hemicolectomy, ileostomy, and transverse colostomy were performed. Although she developed postoperative septicemia, the patient was discharged 38 days after admission. Seven months postoperatively, the patient died of lung, liver, and brain metastases. Even in cases with a lesion that is not completely obstructed, it is important to note that air insufflations during upper GI endoscopy can perforate the intestinal wall in patients with advanced colon cancer.

No MeSH data available.


Related in: MedlinePlus