Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh.

Bogdanić, Branko and Augustin, Goran and Kekez, Tihomir and Mijatović, Davor and Hlupić, Ljiljana and Vanek, Maja (2012) Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh. Collegium Antropologicum, 36 (1). pp. 335-8. ISSN 0350-6134

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Abstract

Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39 degrees C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7 x 10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed.

Abstract in Croatian

PREZENTACIJA PERFORIRANOG TUMORA UZLAZNOG KOLONA KAO KOLOKUTANE FISTULE I ABSCESA PREDNJE TRBUŠNE STIJENKE NA MJESTU OŽILJKA NAKON KOLECISTEKTOMIJE LIJEČENOG EN BLOK RESEKCIJOM UZ KORIŠTENJE BIOLOŠKE MREŽICE ----- Prezentacija karcinoma uzlaznog kolona kao kolokutane fistule na mjestu postoperativnog ožiljka je izrazito rijetka pojava. Bolesnik star 69 godina, javio se u Hitnu službu s petodnevnom anamnezom bolova i smrdljivog sekreta u području ožiljka od elektivne kolescistektomije, koja je bila prije 8 godina. Posljednja tri dana bio je febrilan do 39°C te je imao blagu bolnost u gornjem desnom kvadrantu. Negirao je povraćanje, krv u stolici ili gubitak tjelesne težine. Učinjena kompjuterizirana tomografija s peroralnim kontrastom, pokazala je ekstraluminaciju kontrasta u trbušnu stijenku s nekolko fistula, koje su dosezale do kože. Hitnom medijalnom laparotomijom nađen je tumor uzlaznog kolona, koji infiltrira trbušnu stjenku. Učinjena je desna hemikolektomija s resekcijom trbušne stijenke pune debljine dimenzija 7x10 cm. Defekt trbušne stjenke, bio je preveliki za primarno zbrinjavanje, pa su postavljene dvije gaze 20x20 cm natopljene fiziološkom otopinom, koje su fiksirane za kožu pojedinačnim šavima. Drugi postoperativni dan, zbog kontaminiranosti rane, intraperitonealno postavljena je biološka mrežica (svinjska). Prikazani su slični slučajevi, kao i moguće metode u liječenja sličnih stanja.

Item Type: Article
Departments: Katedra za kirurgiju
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Bogdanić, BrankoUNSPECIFIED
Augustin, GoranUNSPECIFIED
Kekez, TihomirUNSPECIFIED
Mijatović, DavorUNSPECIFIED
Hlupić, LjiljanaUNSPECIFIED
Vanek, MajaUNSPECIFIED
Date: March 2012
Date Deposited: 08 Aug 2012 11:46
Last Modified: 08 Aug 2012 11:46
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/1622

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