Colon Cancer After Acute Diverticulitis Treatment
A 47-year-old male visited the hospital with the complaint of right lower quadrant pain that had started 3 days prior. He had a family history of his mother dying of colon cancer, but no other medical history. At the time of the visit, the physical examination results showed right lower abdominal tenderness, but no rebound tenderness. The peripheral blood examination showed that leucocytes had increased to 11,900/mm3 and the CRP to 12.31 mg/dL; no specific findings were observed on plain abdominal X-ray. The abdominal CT findings suggested 4 cm × 1 cm fluid retention in the proximal ascending colon and abscess formation due to diverticulitis perforation towards the outer wall of the ascending colon. In addition, the centripetal focal wall thickening was concurrent; therefore, colon cancer could not be excluded (). Ultrasound-guided percutaneous abscess drainage was performed, and conservative treatment with intravenous antibiotics (ciprofloxacin, metronidazole) was initiated. Three days later, tubography was performed, and because no residual abscess was found, the patient was discharged seven days after admission. After removal of the drainage catheter in the outpatient clinic, a colonoscopy was recommended due to the possibility of colon cancer. However, the patient did not revisit. Approximately two years later, the patient was readmitted with the main complaint of right lower quadrant pain that had started 1 month prior. The abdominal CT suggested diverticulitis-induced bowel perforation in the middle of the ascending colon, accompanied by a thickening of the wall of the ascending colon of ~7 to 8 cm in length (). A colonoscopy was performed to verify the lesion; the results showed an inflammatory mass surrounding the lumen in the proximal ascending colon accompanied by edema ().\nThe CEA level was 2.8 ng/mL, and the biopsy result was high-grade dysplasia; however, the abdominal CT and colonoscopy findings suggested colon cancer. Therefore, a right hemicolectomy was performed. Based on the surgical specimen, the patient was finally diagnosed with an adenocarcinoma, moderately differentiated, at the T3N2M0 stage. The patient is receiving palliative chemotherapy and has been followed up for 19 months to date.