Simultaneous emergency repair of a ruptured abdominal aortic aneurysm and resection of an unexpectedly discovered sigmoid colon cancer using Hartmann's procedure was successfully performed, with no cancer recurrence at 4 years and 7 months.
Case Report (n=1)
No
Simultaneous resection of an unexpectedly found colon cancer during emergency surgery for a ruptured abdominal aortic aneurysm can be safely performed using Hartmann's procedure to minimize the risk of graft infection.
64歳,男性.突然の腰背部痛と血圧低下のため当院に搬送された.来院時,腹部膨満と臍下部の自発痛,圧痛があり,腹部CTで最大径6.5cmの腎下部大動脈瘤と後腹膜巨大血腫を認めた.腹部大動脈瘤破裂と診断し緊急手術施行,Y字型人工血管置換術を行った.その後の腹腔内検索でS状結腸癌が発見された.進行癌と思われたが明らかな転移は認めなかった.二期手術とした場合の術後合併症による切除時期の遅れを懸念し,同時に3群リンパ節郭清をともなうS状結腸切除術を行った.腸の前処置は未施行で,吻合操作や縫合不全による人工血管汚染の危険を最大限回避するためハルトマン手術を選択した.腫瘍は2型で環周率83%,組織型は中分化腺癌でss,ly(2),v(1),n(－)でstageIIであった.術後合併症はなく4年7カ月間無再発生存中である.
Ikeda et al. (2006) conducted a case report in Ruptured abdominal aortic aneurysm and sigmoid colon cancer (n=1). Simultaneous emergency repair of ruptured AAA and sigmoidectomy (Hartmann's operation) was evaluated on Survival and cancer recurrence. Simultaneous emergency repair of a ruptured abdominal aortic aneurysm and resection of an unexpectedly discovered sigmoid colon cancer using Hartmann's procedure was successfully performed, with no cancer recurrence at 4 years and 7 months.