A 56-year-old woman was diagnosed with colon cancer in 2015. After receiving her first colon cancer surgery, she subsequently received treatment with chemotherapy for 6 times. On September 9, 2016, after a hysterectomy and bilateral oophorectomy surgery, a postoperative diagnosis indicated that she suffered from bilateral metastatic ovarian adenocarcinoma (of the intestine), which was successfully treated. She has since then been under treatment with Avastin and capecitabine. The patient had no history of hypertension, diabetes, coronary heart disease, or any other infectious diseases such as hepatitis and tuberculosis, as well as any drug or food allergies.
According to the patient, she visited an affiliated hospital, Yangzhou University, where she was diagnosed with a malignant pseudo-colon tumor and received her first chemotherapy. After not getting better, she decided to consult the Northern Jiangsu Province Hospital for further treatment.
In 2021-2-23, she visited the Northern Jiangsu Province Hospital, where it was revealed after a CT scan that there was the development of colon cancer. The computed tomography (CT) revealed small nodules in both lungs, a few fibrous cords in both lungs, and the density of the left mammary gland increased. Through colonoscopy of about 60 cm into the lens, anastomosis of the small intestine and colon was observed, with a smooth mucosa. The angle of the local intestine was larger and it was difficult to enter the lens. There were normal colorectal folds, smooth mucosa, an orange-red color, a light texture of blood vessels, and lots of secretions.
In 2021-03-3, the patient underwent positron emission tomography-computed tomography (PET-CT) examinations, which revealed an irregular density of the soft tissues of the umbilical abdominal wall and the density of the anterior rectal soft tissues with an abnormal metabolism of fluorodeoxyglucose (FDG), which is considered to be the cause of malignant lesions. Retroperitoneal multiple small lymph nodes with increased metabolism of FDG are not excluded; after colon cancer, the anastomotic metabolism of FDG increases, which is considered anastomotic stomatitis; the wall of the gastric antrum and duodenal bulb are thickened, and the metabolism of FDG is increased. These CT results were similar to those observed in 2021-2-23.
The physical examination of the patient on 2021-03-21 revealed a malignant tumor of the colon with a tumor of the abdominal wall lasting more than a month. The same examination also revealed a flat and soft abdomen, an old surgical scar of about 8 cm in the middle of the right lower abdomen, no obvious tenderness, no rebound pain throughout the abdomen, no muscle guard, no palpable mass, liver and spleen under the ribs, Murphy's sign (-), mobile numbness (-), bowel sounds 3-5 times per minute, and no sound of water above. The digital rectal examination revealed no abnormalities. She had a history of contact with areas affected by infected water (schistosoma) and dysmenorrhea. The patient had no family history of cancer.
A surgery for the patient was scheduled for January 23, 2021, where the preoperative diagnosis revealed a malignant tumor of the colon with a tumor of the abdominal wall, a secondary malignant tumor of the abdominal cavity, and a malignant tumor of the ovary. They proceeded with laparoscopic, three-stage surgery, partial resection of the small intestine, resection of the abdominal wall mass, partial rectal resection, and sigmoid colostomy with a duration of 3 hours and 50 minutes. When explored, a small amount of ascites was around the umbilicus of the abdominal wall, there was a metastasis of about 3 cm, and there was no intestinal adhesion under the metastasis. The pelvic cavity showed that the anterior wall of the rectum and the cervical stump had a recurrence of about 4 cm, and some small intestinal cancerous adhesions were present in the lesion.