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Totally bypass of anastomoses for an advanced sigmoid cancer with direct duodenal invasion in a 95-year-old man: A rare case summary
Cheng-Wei Fan1, Meng-Hsing Ho2, Chia-Cheng Wen3, Yi-Chiao Cheng3
1 Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
3 Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Correspondence Address:
Yi-Chiao Cheng,
No.325, Sec.2, Cheng-gong Rd., Neihu District, Taipei City 11490
Taiwan
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmedsci.jmedsci_48_22
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The patient is a 95-year-old male with underlying disease of hypertensive cardiovascular disease, Type 2 diabetes mellitus, and old cerebrovascular accident. Persistent abdominal cramping pain with fullness sensation and poor appetite had been noted. The flexible colonoscopy could not pass through sigmoid colon. Abdomen computed tomography demonstrated tumor obstruction over sigmoid colon, measurable size in 5.2 cm, with highly suspicion of duodenum invasion. During operation, tumor which located in the sigmoid colon invaded to fourth portion of the duodenum. En bloc resection of the tumor, duodenorrhaphy, and feeding jejunostomy were performed. An end-to-end anastomosis and protective loop ileostomy formation at the right lower quadrant were performed as totally bypass of anastomoses consequently. Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely in the duodenum involved. In the case presented above, we could aim that active surgical management is useful for improving patient prognosis without increasing the risk associated with surgery.
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