A 70-year-old patient with no history of interest came to the emergency department complaining of loss of consciousness 15 kg, severe asthenia, anorexia and constipation for 2 months.
In the course of the last week, the patient also presented significant left hemiabdomen colic pain with little improvement to usual analgesics.
Physical examination revealed a general mass, mucocutaneous, cardiorespiratory dryness with no abnormalities, and abdomen blushing and palpable with pain at auscultation a lower diameter, quadrant 5-6 cm.
In the admission analysis, the following stand out: Hb: 10.8 g, Hc: 38%, MCV: 78, leukocytes: 13.0/μl, with neutrophilia, Fe: parameters 8,600 within normal limits.
There were no significant changes in chest and abdominal X-rays.
Eight hours after admission, pain in the left iliac fossa worsens, leaving the patient in the central-abdominal area.
Physical examination revealed diffuse crepitation throughout the abdominal wall and signs of peritonitis.
An urgent abdominal CAT scan showed dilation of the intestinal loops caused by the presence of a solid mass of about 10 cm in maximum diameter, located in the left pelvis, which determines stenosis and intestinal obstruction at the si level.
The mass, with more left mamelon contours and left iliac muscle, and in its upper portion appears ulcerated and fistulated to the anterior abdominal wall, which is markedly thickened, with a thickened side.
1.
Diagnosis: neoplasm of the fistulous sigma to the abdominal wall, with consolidation.
Abdominal wall emphysema.
The patient progresses unfavorably, presenting septic shock refractory to treatment during surgery, dying hours later.
Necropsy corroborated the diagnoses made with the imaging test, as well as colon neoplasia which turned out to be adenocarcinoma.
