Abstract
A 49 years old male was admitted emergently with acute right hypochodralgia. Based on a large defect demonstrated on barium enema study, a probable diagnosis of carcinoma of the asending colon was made and a laparotomy was performed. Marked adhesion was found between the right colon, post-bulbar portion and gall-bladder. Because of the difficulty in separation of the adhesion, an ileotransversostomy was performed. No malignant findings were obtained from the specimen of this region. Post-operatively, the findings in the ascending colon noted on barium enema study were not visible. Duodenofiveroscopy, performed immediately after operation revealed an ulcerative lesion at the post-bulbar portion. Biopsy under direct vision revealed well differentiated adenocarcinoma. The endoscopic picture suggested carcinomatous invasion secondary to the other tumor. A second laparotomy was performed to identify the primary lesion. Separation of the adhesion revealed a small carcinoma at the tip of the appendix which was deviated to a cranial direction. This carcinoma had infiltrated the duodenum and a portion of the colon. Initially, this carcinoma probably perforated, causing the acute symptoms. Subsequently, inflammation around the lesion caused ulceration of the asending colon and the severe adhesive changes.
