Abstract
Patient 1, a 78-year-old man, was seen at the hospital because of epigastralgia. There was muscular defense in the right lower quadrant of abdomen. On blood analysis CEA level was high. An abdominal x-ray film and an abdominal CT scan did not show intra-abdominal free air but abnormal gaseous image in the mesentery. Emergency operation was performed with a diagnosis of peritonitis associated with cancer, and we found ascending colon cancer and feces in the mesentery. Right hemicolectomy was thus performed. The removed material revealed a type I tumor and penetration proximal to it on the mesentery side of the ascending colon. An ischemic change was identified on the mucosa.
Patient 2, a 73-year-old man, was brought into our hospital by ambulance because of abdominal pain. An abdominal CT scan showed abnormal gaseous image in the mesentery. Emergency operation was performed with a diagnosis of penetration of the mesentery of the ascending colon. Upon laparotomy, massive fecal masses in the mesentery and ascending colon cancer were disclosed. Right hemicolectomy was thus performed. On the removed material, there were a type 3 tumor and a penetrated portion proximal to it on the mesentery side of the ascending colon. Pathological studies showed circulatory impairment at the penetrated portion. Their postoperative courses were comparatively uneventful and they were discharged from the hospital.
Ascending colon cancer associated with intramesenteric penetration is a rare entity. In our cases, abdominal CT scanning is useful for making diagnosis of the disease and simultaneous anastomosis during emergency operation was performed with saving their lives.
