Colitis-associated Colorectal Cancer Diagnosed after Descending Colon Perforation in a Patient with Crohn's Disease

Abstract

The patient, a 38-year-old man, was diagnosed with Crohn's disease at the age of 12 years. Since then, he had been treated with immunomodulators and anti-TNF-alpha antibody preparations, and his condition had been stable. He presented to the emergency department of the hospital with a chief complaint of fever and left-sided abdominal pain. When he came to our hospital, he had a fever (38.8 °C) and tenderness localized to the left side of the abdomen, but there was no evidence of peritoneal irritation. Blood hematological and biochemical tests showed an elevated inflammatory response. Simple computed tomography (CT) of the abdomen showed soft tissue shadows and increased fat stranding in the dorsal descending colon, and a diagnosis of perforation of the descending colon and abscess formation due to exacerbation of Crohn's disease was made. The patient's general condition was stable, and conservative treatment with fasting and antimicrobial agents was started. After the inflammatory response improved, a laparoscopic descending colon resection was performed. The patient had an uncomplicated postoperative course. The final histopathological result was mucinous carcinoma, pT3N0M0, pStage IIa. Two months after surgery, he underwent adjuvant chemotherapy for descending colon cancer.