Clinical analysis of colon cancer combined with abdominal abscess

Objective To summarize the clinical characteristics, preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess. Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed. All the patients underwent laboratory tests and imaging examinations before operation. According to the principles of operative safety and radical resection of tumor, 41 patients underwent open operation and then received the fluid infusion, antibiotic treatment, parenteral nutrition support and symptomatic treatment after operation. Patients were followed up via telephone interview and outpatient examination till August 2014. Results All the 41 patients had different levels of obstruction and infection at admission, and concomitant diabetes mellitus were detected in 26 patients, essential hypertension in 21 patients, heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients. The results of laboratory tests showed that there were 4 patients with hemoglobin (Hb) 90 g/L, 36 patients with albumin (Alb) <30 g/L, 18 patients with increased glycosylated hemoglobin (GHb) , 41 patients with increased serum procalcitonin and 10 patients with increased blood carcinoembryonic antigen (CEA) . Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT, intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients, the metal stent endoprosthesis was placed in 2 patients to relieve obstruction. Fifty-nine strains of bacteria were cultured from 41 copies of the pus (28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation) , and most of them were escherichia coli with a percentage of 61.0% (36/59) and were sensitive to imipenem. All patients underwent open surgery including 33 patients combined wtih enterostomy. The operation time was 150-272 minutes with a median time of 221 minutes. The volume of intraoperative blood loss was 100-800 mL with a median volume of 370 mL. The tumor located at the ileocecal valve was detected in 6 patients and ascending colon in 9 patients, and then palliative or radical right hemicolectomy was performed. The tumor located at the hepatic flexure of colon was detected in 2 patients and then radical extended right hemicolectomy was performed. The tumor located at the splenic flexure was detected in 4 patients and descending colon in 7 patients, and then the radical resection and terminal ileostomy were performed. Among 13 patients with tumor located at the sigmoid colon, 12 patients received radical resection and 1 patient received palliative resection. Eleven patients were complicated with pulmonary infection, 6 patients with infection or dehiscence of incision, 5 patients with anastomotic leakage, 4 patients with ureteral injury, 4 patients with heart failure, 3 patients with paralytic intestinal obstruction, 2 patients with septicemia, 1 patient with renal failure, 1 patient with cerebral infarction and 1 patient with pulmonary embolism. Nine patients died after operation. The diameter of resected tumor was 4.5-15.0 cm with a median diameter of 9.4 cm. High-differentiated tumors were detected in 25 patients, moderate-differentiated tumors in 12 patients and low-differentiated tumors in 4 patients (signet-ring cell carcinoma in 1 patient) . There were 4 patients in the T3 stage of tumor and 37 patients in the T4 or T4b stage. The number of lymph node dissection was 23 (range, 15-35 ) with 18 positive lymph nodes. Six patients had lymph node metastasis. Twenty-eight patients were followed up for a median time of 27 months (range, 3-80 months) . During the follow-up, 16 patients died and 12 patients survived, 10 patients died of tumor recurrence and metastasis, 6 patients died of other diseases, 4 patients had tumor recurrence and metastasis and 8 patients had no recurrence and metastasis. Conclusions Patients with colon cancer combined with abdominal abscess are usually complicated with internal diseases, with a high mortality. Surgical treatment is the only curative treatment option, but an accurate preoperative evaluation is essential and the opportunity of operation should be evaluated before operation, the injury of ureteral , vascular and other surrounding important structures should be avoided during operation, meanwhile, intraoperative application of enterostomy could reduce anastomosis-related complications. After operation, routine peritoneal lavage and antibiotics according to the drug sensitive test are conducted for reducing the postoperative complications and mortality. Key words: Colonic neoplasms; Abdominal abscess; Surgical procedure, operative