The causes of intestinal obstruction are diverse with tissue adhesion, incarcerated hernia, and large bowel neoplasm being the most common causes. Cancer is not easy to diagnose in patients with a history of intestinal obstruction after the intraperitoneal operation following blunt trauma. Herein, we report the case of a patient who was diagnosed with colon cancer after undergoing adhesiolysis due to intestinal obstruction.
Postoperative bowel obstruction occurs frequently and may require emergency surgery [
A 59-year-old man was transferred to our trauma center for postoperative intestinal obstruction that had not improved with nonsurgical treatment for more than 3 weeks. Four years ago, the patient had undergone emergency surgery due to hemopneumoperitoneum from a pedestrian traffic accident. Ileum perforation, cecum serosa tearing, small bowel, and cecal mesentery hematoma were identified intraoperatively, but no active bleeding was found. The patient had undergone ileum primary repair, cecal serosa primary repair, and incidental appendectomy based on the surgeon’s judgment. Postoperative small bowel obstruction occurred after surgery and improved after about 50 days with nonoperative management.
Since then, there had been no history of bowel obstruction. At the time of transfer, there were no laboratory findings that suggested inflammation. Abdominal computed tomography (ACT) showed no findings suggestive of ischemia or necrosis, even though the small and large intestines were dilated; however, an abrupt narrowing site was identified at the descending-sigmoid colon junction (
Two weeks after the operation, the patient’s symptoms did not improve; hence, tests for intestinal obstruction were performed. It was confirmed by the small bowel series that part of the intestinal contents was passed (
Adhesion, increased hernia, and large bowel cancer are the main causes of total bowel obstructions [
No potential conflict of interest relevant to this article was reported.
Abdominal computed tomography was performed after intestinal obstruction operation. (A) admission day, (B) 10 days after, and (C) 3 weeks after. Both small and large bowels were dilated; however, the mucosal wall was enhanced well. Arrows indicate the stenotic site of the colon with mild mucosa wall thickening.
A photograph was taken during the operation of adhesiolysis. The small intestine was attached to the abdominal wall in the left lower quadrant region in a V-shape.
Small bowel series: (A) after 2 hrs, (B) after 3 hrs, and (C) after 1 day. Successive inspections showed that majority of the contrast was retained in the intestine and some descended into the rectum.
Follow-up abdominal computed tomography. A masslike lesion with an apple core sign was seen at the descendingsigmoid colon junction site.
Sigmoidoscopic image. A cancer-like lesion encircled the lumen.