2026 年 76 巻 1 号 p. 75-79
No studies have clearly defined an optimal treatment strategy for colorectal cancer incidentally detected during emergency surgery. We report a case of colorectal cancer invading adjacent organs, discovered after upper gastrointestinal perforation and treated using emergency curative surgery. A 77-year-old woman presented with chest and back pain and hematemesis. Contrast-enhanced computed tomography revealed free intraperitoneal air, ascites, increased fat stranding around the duodenum, and a mass in the ascending colon. Accordingly, upper gastrointestinal perforation-induced acute generalized peritonitis was diagnosed, necessitating emergency surgery. Intraoperative findings included a 10-mm perforation in the anterior wall of the duodenal bulb, which was sutured and closed, followed by omental patching. An 80-mm mass in the ascending colon, suspected of invading the sigmoid colon, was identified; peritoneal dissemination or liver metastasis was not evident. The patient’s vital signs were stable intraoperatively, and owing to concerns regarding staged surgery following tumor-induced obstruction or peritonitis, right hemicolectomy (D3) with en bloc resection of the sigmoid colon was performed. Pathological examination confirmed ascending colon cancer with invasion into the sigmoid colon. The patient recovered uneventfully and was discharged on postoperative day 10. The timing of curative resection for incidentally detected colorectal cancer should be determined on a case-by-case basis, considering the clinical situation.
