Acute appendicitis and postoperative fecal fistula: Symptoms of an unrecognized carcinoma of the colon
Tóm tắt
This report is a retrospective evaluation of 12 case histories. All patients had been subjected to laparotomy on suspicion of acute appendicitis. The operative situations seemed to corroborate clinical expectations: an inflamed ileocecal process was assumed to be a result of perforation of a gangrenous appendicitis. In three patients a primary adenocarcinoma arising from the appendiceal base was the incidental histologic finding postoperatively. In three other patients this inflammatory-looking process was related to a cecal carcinoma. In six patients a carcinoma existed unrecognized as the basic disease, these patients being subjected to intra-abdominal drainage only or in connection with appendectomy. In five instances a fecal fistula was the main persisting symptom of postoperative morbidity, in one patient even as long as two years after laparotomy. The problem in diagnostic verification of the initially unidentified carcinoma is illustrated. Attention is directed towards avoiding a false feeling of security in the presence of inflammatory manifestations in the right lower abdominal quadrant, which may misleadingly suggest a ruptured appendix.
Tài liệu tham khảo
Anschütz W: Ueber den Verlauf des Ileus bei Darmcarcinom und den localen Metcorismus des Coecum bei tiefsitzendem Dickdarmverschluss. Arch Klin Chir 68: 195, 1902
Balslev I, Jensen HE, Nielsen J: Carcinoma of the colon: A review of 554 patients. Acta Chir Scand 137: 175, 1971
Ger R, Buch J, Held BT, et al: Carcinoma of the appendix: Report of two cases. Dis Colon Rectum 17: 370, 1974
Gerhart A: Klinische Beobachtungen über Neubildungen am Zökum. Bruns Beitr Klin Chir 204: 191, 1972
Giersberg O: Cöcalfisteln nach Appendektomien als folge aboral gelegener Colontumoren. Chirurg 38: 561, 1967
Goligher JC: Surgery of the Anus, Rectum and Colon. Third edition. London, Bailiere, Tindall & Cox, 1975, p 483
Goligher JC, De Dombal FT, Burton I: Crohn's disease, with special reference to surgical management. Prog Surg 10: 1, 1972
hansen G, Hess W, Mitzscherling, B: Die Indikation der Appendektomie nach Auswertung von 4258 pathologisch-histologischen Untersuchungen. Chirurg 46: 239, 1975
Lichtenstein ME, Myers WH, Dwyer GF Jr: Perforation of the cecum from obstructing carcinoma of the distal colon. Am J Surg 101: 26, 1961
Long JC: Discussion. Tex J Med 49: 226, 1953
Markgraf WH: Cecal carcinoma masked by acute appendicitis. Am J Surg 95: 998, 1958
McAdams AJ: Discussion. Am J Surg 84: 527, 1952
Parkash O: Statistical and etiological aspects of carcinoma of the large intestine: A study based on autopsy data from 1928–1972. Digestion 11: 115, 1974
Patterson HA: The management of cecal cancer discovered unexpectedly at operation for acute appendicitis. Ann Surg 143: 670, 1956
Peltokallio P: Carcinoma of the colon: A clinical study of 603 patients. Acta Chir Scand suppl 350: 62, 1965
Ransom HK: Carcinoma of the colon: A study of end-results of surgical treatment. Arch Surg 64: 707, 1952
Smith JS, Young S, Gillespie G, et al: Epidemiological aspects of Crohn's disease in Clydesclale 1961–1970. Gut 16: 62, 1975
Steinberg M, Cohn I Jr: Primary adenocarcinoma of the appendix. Surgery 61: 644, 1967
Stelzner F, Lierse W: Über die Ursache der Appendicitis. Langenbecks Arch Chir 330: 273, 1972
Williams AM: Inflammatory masses of the cecum. Ann Surg 165: 697, 1967