胃腸および消化器系

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Sigmoid Perforation during CT Colonography in a Patient with an Inguinal Hernia and Concomitant Finding of a Right-Sided Colon Cancer

Turner J, Page M, Clark C, Khanduja K

The use of computed tomography colonography or virtual colonography (VC) is gaining acceptance as a screening modality for colon cancer. A comprehensive understanding of VC complications is limited. We report a case of colon perforation in a patient where a colon cancer was diagnosed using VC colonography with manual insufflation. A 79-year-old patient underwent a VC after a failed screening optical colonoscopy (OC). The initial radiological findings included a large amount of mesoperitoneum and retroperitoneal air near the proximal sigmoid and a left inguinal hernia containing the distal sigmoid colon suggesting a colonic perforation caused by colonic obstruction. Subsequent radiological interpretation revealed a 1.5 cm lesion in the posterior cecum. The patient underwent repair of the hernia, sigmoid resection for sigmoid perforation, followed by intra-operative colonoscopy (which confirmed the radiographic findings of a cecal lesion) and right colectomy. Pathologic examination confirmed the T3, N0, MX adenocarcinoma.