类似直肠癌腹膜播散的放线菌病感染:病例报告。

IF 0.7 Q4 SURGERY
Yukiko Fukunaga, Hiromichi Maeda, Sachi Yamaguchi, Miho Tsutsui, Ken Okamoto, Tomoki Tanaka, Masahiro Maeda, Akira Marui, Tsutomu Namikawa, Michiya Kobayashi, Satoru Seo
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引用次数: 0

摘要

背景:放线菌病是一种化脓性肉芽肿炎症,通常由以色列放线菌(Actinomyces israelii)引起。由于其罕见性和缺乏特征性临床特征,腹腔内放线菌病的诊断具有挑战性,尤其是当患者有腹部癌症治疗史时:患者是一名 72 岁的男性,曾因直肠癌接受过多次腹部手术,包括原发性直肠癌低位前切除术、肝转移灶肝部分切除术和局部复发的 Hartmann 手术。患者还接受了使用 Sugarbaker 方法进行的腹膜旁疝修补术。疝修补术一年后,计算机断层扫描(CT)发现腹壁和网片之间有肿块病变,提示直肠癌腹膜复发的可能性。正电子发射计算机断层扫描(PET-CT)显示氟脱氧葡萄糖(FDG)蓄积,而肿瘤标志物水平在正常范围内。开腹手术时,观察到小肠、腹壁、网膜、结肠和造口与肿块病变相关,于是进行了全切。然而,术后组织病理学检查发现放线菌感染,没有发现任何癌细胞:本病例凸显了外科医生在放线菌病的术前诊断方面所面临的挑战,尤其是在腹部癌症切除术后发生放线菌病时。此外,本病例还提醒我们在开始化疗前对腹部肿块或结节进行组织病理学检查的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An actinomycosis infection resembling peritoneal dissemination of rectal cancer: a case report.

Background: Actinomycosis is a suppurative and granulomatous inflammation commonly caused by Actinomyces israelii. Due to its rarity and the paucity of characteristic clinical features, diagnosis of intra-abdominal actinomycosis is challenging, especially when the patient has a treatment history of abdominal cancer.

Case presentation: The patient is a 72-year-old man who has a history of multiple abdominal surgeries for rectal cancer, including low anterior resection for primary rectal cancer, partial hepatic resection for metachronous liver metastasis, and Hartmann surgery for local recurrence. The patient has also undergone parastomal hernia repair using the Sugarbaker method. One year after hernia repair, computed tomography (CT) identified a mass lesion between the abdominal wall and the mesh, suggesting the possibility of peritoneal recurrence of rectal cancer. The accumulation of fluorodeoxyglucose (FDG) was evident via positron emission tomography-CT (PET-CT), while tumor marker levels were within the normal range. On laparotomy, the small intestine, abdominal wall, mesh, colon, and stoma were observed to be associated with the mass lesion, and en bloc resection was carried out. However, postoperative histopathological examination revealed an actinomyces infection without any cancerous cells.

Conclusions: This case highlights the challenges faced by surgeons regarding preoperative diagnosis of actinomycosis, especially when it occurs after the resection of abdominal cancer. Also, this case reminds us of the importance of a histopathological examination for abdominal masses or nodules before starting chemotherapy.

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