A Patient with an Isolated Small Intestinal Metastasis after Surgery for Perforated Sigmoid Colon Cancer

Abstract

A 61-year-old woman was diagnosed with a lower bowel perforation in October 2006 and underwent emergency surgery on the same day. Perforation of a type 2 advanced cancer of the sigmoid colon was found. A sigmoid colectomy, construction of an artificial anus, and lavage and drainage were performed. Histopathology showed a well-differentiated adenocarcinoma (se, ly1, v1, n1, stage IIIa). Reclosure was performed on postoperative day 43 because of wound dehiscence. The patient then received chemotherapy with S-1 for 1 year.
In January 2008, the artificial anus was closed, and re-anastomosis was performed. During that surgery, a submucosal tumor in the ileum, about 20 cm proximal to the terminal ileum, was found and resected. There were no other findings such as ascites or peritoneal metastases. Histopathology of the submucosal tumor showed that the muscularis mucosae was preserved, and an asynchronous metastasis from the sigmoid colon cancer to the small intestine, which appeared similar to the histologic findings at initial surgery, was diagnosed. The metastasis was well-differentiated adenocarcinoma from the submucosa to the subserosa, but it did not extend to the mucosal surface or the serosal surface. This suggested a hematogenous or lymphogenous metastasis.