Colon Cancer After Acute Diverticulitis Treatment
A 46-year-old male visited the hospital with the complaint of right lower quadrant pain that had started approximately 1 week prior. At the time of the visit, the patient still had right lower abdominal tenderness and rebound tenderness. The peripheral blood examination showed that the leucocyte level had increased to 12,300/mm3 and the CRP to 2.42 mg/dL, and a plain abdominal X-ray showed no abnormalities. The abdominal CT revealed a diverticulum in the proximal ascending colon and a focal wall thickening of ~6 cm in the surrounding area, accompanied by peripheral fat infiltration and inflammation, although the appendix was normal. However, lymph nodes around the ileum were enlarged, so colon cancer could not be excluded (). Clinically, the patient was diagnosed with acute diverticulitis, and the symptoms improved after 5 days of antibiotics (ciprofloxacin) and conservative treatment. One month after discharge, a follow-up colonoscopy was performed for colon cancer differentiation. The colonoscopy showed irregular boundaries surrounding most of the lumen in the proximal ascending colon and an ulceroinfiltrative mass accompanied by changes in the mucosal layer (). The biopsy results confirmed an adenocarcinoma, poorly differentiated, with signet ring cells and a CEA level of 14.4 ng/mL. The patient underwent a laparotomy, but peritoneal seeding was found in all intraperitoneal areas and was strongly adhered in the ileum. Furthermore, because there was an obstruction in the lesion, only simple bypass surgery (ileum-transverse colon) was performed. Subsequently, the patient received palliative chemotherapy, but died 253 days from the date of surgery.