Metachronous cancer of the large intestine.
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Two patients had duodenocolic fistulas, each following a carcinoma of the colon in the area of the hepatic flexure that had perforated into the duodenum. The first patient was treated by a radical pancreatoduodenectomy with right colectomy; the second by subtotal colectomy with excision of the duodenal wall and suture. Both patients are alive and without evidence of recurrent disease. In addition, the first patient had two other primary carcinomas, in the cecum and in the stomach, and the second patient had another primary in the sigmoid. The definitive procedure had to be adjusted to encompass all lesions. The radical operation in one stage seems to be the preferred procedure and certainly is most satisfactory as a cancer operation. Our patient treated by this procedure has survived more than 11 years. An intestinal fistula related to colonic carcinoma, evan though rare, should not be considered as a separate entity. Treatment of the cancer with an en-bloc resection of the communicating organs should be employed if possible.
A woman suffering from recurrent attacks of abdominal pain was found at operation to have a fibroma of the cecum. The clinical, operative and pathologic findings are described. The medical literature was reviewed and the lesion was found to be uncommon. The importance of specific histologic stains to distinguish the true fibroma from other spindle-cell tumors is stressed.
A 9-mm granular-cell myoblastoma of the cecum found incidentally during appendectomy in a 17-year-old-girl is reported. Electronmicroscopic findings favor origin of the granular cells from an undifferentiated mesenchymal (fibroblast-like) cell. Review of the small number of previously reported cases revealed three involving the cecum, one each in the ascending and transverse colon and two in the rectum. Four patients were asymptomatic and their lesions were found incidentally. Three lesions simulated maligancy clinically; these patients underwent right hemicolectomy.
A 16-year-old Negro girl underwent exploratory laparotomy for ileocecal intussusception and was found to have moderately well-differentiated mucin-producing adenocarcinoma of the ileocecal valve. Specific aspects of this disease in children are discussed and an appeal for early diagnostic studies in cases of children who complain of weight loss, chronic constipation, and abdominal pain is made. Finially, on the basis of the natural history of the disease, a "second-look" operation is recommended.
We report the unusual concatenation of cecal carcinoma complicated by bacteremia and purulent pericarditis. The organism responsible for the pericarditis was not definitely established. The pericarditis was successfully managed by surgical drainage and antibiotic therapy. Colonic surgery followed eradication of the pericarditis.
A 68-year-old woman, who was treated with 5-fluorouracil (5-FU) intravenous therapy weekly for variable periods following hemicolectomy for adenocarcinoma of the cecum, had at least two well-described episodes of mental confusion, disorientation, and deterioration, in the absence of cerebellar tract signs. The sensorium cleared after cessation of 5-FU, only to deteriorate following readministration of the drug. She was thought to have organic brain syndrome during her most recent mental relapse. Her mental status has now been intact for more than one year since her last exposure to 5-FU. This is believed to be the third patient who has shown mental changes which could be attributable to 5-FU toxicity. Since 5-FU is the most frequently used chemotherapy for the treatment of colonic cancer, it is important that this form of toxicity be recognized lest subject patients be judged to have irreversible organic brain syndrome or metastatic carcinoma.
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Regional chemotherapy through a catheter placed in the hepatic artery is routinely used for treatment of unresectable liver metastasis from colon carcinoma. With some frequency, anatomical variations of the hepatic artery, including compression of the celiac axis, are found, and must be recognized preoperatively for appropriate management and placement of the catheter. We report a case of a colon cancer patient with multiple liver metastases and compression of the celiac axis, who received decompression of the celiac axis and catheterization of the hepatic artery.