直腸癌の穿通により骨盤内膿瘍を形成した一例

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  • A Case of Penetrated Rectal Cancer with Pelvic Abscess
  • チョクチョウガン ノ センツウ ニ ヨリ コツバン ナイ ノウヨウ オ ケイセイ シタ イチレイ

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A 66-year old man visited a nearby clinic with the chief complains of lower limbs numbness, melena and high fever. He was admitted to our hospital for further examination. Abdominal computed tomography showed a giant pelvic abscess. Colonoscopy revealed rectal cancer with severe rectal stenosis. A diagnosis of pelvic abscess resulting from penetration of rectal cancer was made. On computed tomography, the abscess was found to be localized to the rectum below the peritoneal reflection, and there were no signs of pan-peritonitis. Percutaneous abscess drainage was firstly performed, because the patient’s general condition was not serious. Transient improvement was noted in the inflammation, however, eventually a double-barrel sigmoid colostomy was necessitated by an increase in the size of the abscess cavity. Approximately one month after the surgery, abdomino-perineal resection of rectum was done for the rectal cancer. Although infection of the pelvic dead space was transiently found after surgery, the patient was discharged without the other major complications. At present, the patient is receiving postoperative adjuvant chemotherapy with UFT/Uzel, and has shown no evidence of recurrence of the cancer. Since we should keep in minds the peritoneal dissemination in cases of patients with cancer penetration, meticulous follow-up is necessary.

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