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Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report

INTRODUCTION: Colonic ischemia is challenging to diagnose preoperatively. We present a patient with colonic ischemia, initially considered to have colonic obstruction. We review the history, physical findings, imaging, operative documents and postoperative diagnosis of this patient with an atypical...

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Autores principales: Kimura, Jiro, Lefor, Alan Kawarai, Kubota, Tadao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000759/
https://www.ncbi.nlm.nih.gov/pubmed/29679809
http://dx.doi.org/10.1016/j.ijscr.2018.04.008
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author Kimura, Jiro
Lefor, Alan Kawarai
Kubota, Tadao
author_facet Kimura, Jiro
Lefor, Alan Kawarai
Kubota, Tadao
author_sort Kimura, Jiro
collection PubMed
description INTRODUCTION: Colonic ischemia is challenging to diagnose preoperatively. We present a patient with colonic ischemia, initially considered to have colonic obstruction. We review the history, physical findings, imaging, operative documents and postoperative diagnosis of this patient with an atypical presentation of colonic ischemia. PRESENTATION OF CASE: A 74-year old female presented with dyspnea on exertion and melena. A tumor in the sigmoid colon was identified by colonoscopy and biopsy showed adenocarcinoma. After admission, she developed abdominal pain. Computed tomography scan revealed the mass in the sigmoid colon and dilation of the proximal colon. She was diagnosed with colonic obstruction due to the sigmoid cancer and emergent transverse loop colostomy was performed. Postoperatively she developed hypotension and the colostomy appeared ischemic. Emergent reoperation showed ischemia from the ileum to the sigmoid colon. Despite resection, the patient died postoperatively of multiple organ system failure. DISCUSSION: The resulting delay in diagnosis of colonic ischemia likely contributed to the poor outcome. Imaging studies play a key role in the management of acute abdominal emergencies. However, imaging can be misleading because it is only a “radiological diagnosis”. A radiological diagnosis makes sense when it is the same as the “clinical diagnosis”. An emphasis must be placed on history taking and physical examinations. CONCLUSION: It is difficult to diagnose colonic ischemia in patients with suspected colonic obstruction due to colon cancer. The imaging studies in these patients may be misleading, resulting in adverse outcomes.
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spelling pubmed-60007592018-06-15 Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report Kimura, Jiro Lefor, Alan Kawarai Kubota, Tadao Int J Surg Case Rep Article INTRODUCTION: Colonic ischemia is challenging to diagnose preoperatively. We present a patient with colonic ischemia, initially considered to have colonic obstruction. We review the history, physical findings, imaging, operative documents and postoperative diagnosis of this patient with an atypical presentation of colonic ischemia. PRESENTATION OF CASE: A 74-year old female presented with dyspnea on exertion and melena. A tumor in the sigmoid colon was identified by colonoscopy and biopsy showed adenocarcinoma. After admission, she developed abdominal pain. Computed tomography scan revealed the mass in the sigmoid colon and dilation of the proximal colon. She was diagnosed with colonic obstruction due to the sigmoid cancer and emergent transverse loop colostomy was performed. Postoperatively she developed hypotension and the colostomy appeared ischemic. Emergent reoperation showed ischemia from the ileum to the sigmoid colon. Despite resection, the patient died postoperatively of multiple organ system failure. DISCUSSION: The resulting delay in diagnosis of colonic ischemia likely contributed to the poor outcome. Imaging studies play a key role in the management of acute abdominal emergencies. However, imaging can be misleading because it is only a “radiological diagnosis”. A radiological diagnosis makes sense when it is the same as the “clinical diagnosis”. An emphasis must be placed on history taking and physical examinations. CONCLUSION: It is difficult to diagnose colonic ischemia in patients with suspected colonic obstruction due to colon cancer. The imaging studies in these patients may be misleading, resulting in adverse outcomes. Elsevier 2018-04-16 /pmc/articles/PMC6000759/ /pubmed/29679809 http://dx.doi.org/10.1016/j.ijscr.2018.04.008 Text en © 2018 The Author(s) http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Kimura, Jiro
Lefor, Alan Kawarai
Kubota, Tadao
Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title_full Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title_fullStr Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title_full_unstemmed Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title_short Colonic ischemia mimicking obstruction due to sigmoid colon cancer: A case report
title_sort colonic ischemia mimicking obstruction due to sigmoid colon cancer: a case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000759/
https://www.ncbi.nlm.nih.gov/pubmed/29679809
http://dx.doi.org/10.1016/j.ijscr.2018.04.008
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