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Colon Cancer post GSW

Blueflightmedic trauma at emergencyunit.com
Sat May 21 09:07:09 BST 2011


I am put in mind of Marjolin's ulcer. However, one case does not make a
diagnosis, and there must be many people who have injuries to the colon
(including surgery) and do not have anastomotic tumour. Interesting idea,
but no evidence.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Miki
Sent: 17 May 2011 19:54
To: trauma-list at trauma.org
Subject: Colon Cancer post GSW

I would like to have the opinion of the trauma members on this long surgical
story.

 

A young man was severely injured during the 1973 conflict ("October war").
He underwent a Rt. Hemicolectomy, partial jejunal resection and omentectomy
with jejuno-ileostomy and ileo-transversostomy. The postoperative course was
complicated by necrosis of the abdominal wall and a fecal fistula at the Rt.
Flank. He was discharged 7 weeks post injury. 

 

Thirty-three (33) years later he underwent an emergent laparotomy for an
obstructing carcinoma of the sigmoid. A subtotal colectomy was carried out
with ileo-sigmoidostomy. This operation was complicated by severe adhesions.
Several iatrogenic enterotomies were sutured in an attempt to save most of
the remaining small bowel. The pathological examination revealed a mucin
producing Adenoca. 6 cm in its maximal dimension, invading the whole colonic
wall, into the pericolic fat. Lymph nodes were free of tumor. The
postoperative course was complicated by an entero-cutaneous fistula that
persisted for more than a year.

 

He was treated with chemotherapy, but the tumor recurred. This time,
involving the abdominal wall and several loops of small bowel. The patient
succumb during 2008, two years after the resection of the obstructing tumor.

 

The following questions rose:

 

1.       Could there be any connection between the severe injury and the
sigmoid cancer?

2.       If there is such a connection, is it influenced by multiple
transfusions and/or by the length of the remaining bowel?

3.       Could the original injury and surgery cause a delay in diagnosis
and treatment of the obstructing tumor?

4.        Is there any connection between the complicated surgery for the
obstructing tumor and its rapid progression?

 

I would appreciate your input into this case,

 

Michael Muggia, M.D.

Dept. of Surgery,

E. Wolfson Medical Center

Holon, Israel 

 

 

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