A CASE OF ADVANCED CANCER OF THE TRANSVERSE COLON WITH AN ABDOMINAL WALL ABSCESS

An 88-year-old woman was admitted to the institution because of an abdominal mass and fever, 38.3°C. Examination revealed a protruding lesion with the reddish and edematous skin to the left of the umbilicus overlying a tender mass about 10 cm in diameter. Abdominal ultrasonography and CT scanning revealed an abscess in the abdominal wall and a contiguous mass in the peritoneal cavity. Drainage of the abscess was performed and a small amount of pus was obtained. A gastrograffin enema revealed stenosis of the transverse colon. Laparotomy was performed under a diagnosis of cancer of the transverse colon with involvement of the abdominal wall. On opening the abdominal cavity with a transverese incision, a tumor of the transverse colon was found fixed to the abdominal wall. Right hemicolectomy and resection of the abdominal wall including the abscess were performed. Macroscopic examination of the resected specimen showed invasion of the abdominal wall by the transverse colon carcinoma and abscess in the subcutaneous fat, while histological examination revealed a well differentiated adenocarcinoma that had invaded below the abscess wall. In patients with advanced colonic cancer and involvement of the abdominal wall, a flexible abdominal incision or reconstruction of the abdominal wall with a musculo-cutaneous flap would enable us to perform a complete resection of the lesion.