The Korean Journal of Medicine

  • 제82권4호
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  • Pages.459-464
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  • 2012
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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급성 게실염으로 오인된 진행성 대장암 1예

A Case of Colon Cancer with Ovarian Metastasis Mimicking Acute Diverticulitis

  • 윤지현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 박정수 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 정다현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 김지현 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 윤영훈 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 박효진 (연세대학교 의과대학 강남세브란스병원 내과) ;
  • 이상인 (연세대학교 의과대학 강남세브란스병원 내과)
  • Yoon, Ji-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Jung-Soo (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jung, Da-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jie-Hyun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Young-Hoon (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hyo-Jin (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Sang-In (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 발행 : 2012.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

저자들은 복통 및 발열을 주소로 내원하여 시행한 복부 전산화 단층 촬영상 구불결장의 게실염 의심 소견을 보여 항생제 치료 후 증상 호전되어 퇴원한 여자 환자에서 퇴원 후 외래추적 중 복부 불편감 및 빈혈이 있어 시행한 복부 전산화 단층 촬영상 동일한 위치의 대장암 및 좌측 난소의 전이 의심 소견 보여, 대장내시경을 통한 조직검사상 대장암을 확진 받고 수술적 치료를 시행 받은 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Colonic diverticulitis develops in 10-25% of patients with colonic diverticulosis. Most patients complain of lower abdominal pain and fever. The complications of diverticulitis are abscess, fistula, bowel obstruction, free perforation, and panperitonitis. The relationship between diverticulitis and colon cancer is complicated and conflicted. We report a 35-year-old woman diagnosed with metastatic colon cancer, who initially presented with acute colonic diverticulitis in the same location 3 months earlier. To the best of our knowledge, this is the first case of colon cancer with ovarian metastasis presenting as acute diverticulitis.

키워드

참고문헌

  1. Meurs-Szojda MM, Terhaar sive Droste JS, Kuik DJ, Mulder CJ, Felt-Bersma RJ. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis 2008;23:979-984. https://doi.org/10.1007/s00384-008-0510-4
  2. Stefansson T, Ekbom A, Sparen P, Pahlman L. Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study. Scand J Gastroenterol 2004;39:743-747. https://doi.org/10.1080/00365520410003272
  3. Stefansson T, Ekbom A, Sparèn P, Pahlman L. Increased risk of left sided colon cancer in patients with diverticular disease. Gut 1993;34:499-502. https://doi.org/10.1136/gut.34.4.499
  4. Sakhnini E, Lahat A, Melzer E, et al. Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study. Endoscopy 2004;36:504-507. https://doi.org/10.1055/s-2004-814398
  5. Loffeld RJ, van der Putten AB. Diverticular disease of the colon and concomitant abnormalities in patients undergoing endoscopic evaluation of the large bowel. Colorectal Dis 2002;4:189-192. https://doi.org/10.1046/j.1463-1318.2002.00328.x
  6. Comparato G, Pilotto A, Franze A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis 2007;25:151-159. https://doi.org/10.1159/000099480
  7. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet 2004;363:631-639. https://doi.org/10.1016/S0140-6736(04)15597-9
  8. Soran A, Harlak A, Wilson JW, et al. Diverticular disease in patients with colon cancer: subgroup analysis of national surgical adjuvant breast and bowel project protocol C-06. Clin Colorectal Cancer 2006;6:140-145. https://doi.org/10.3816/CCC.2006.n.031
  9. Krones CJ, Klinge U, Butz N, et al. The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia. Int J Colorectal Dis 2006;21:18-24. https://doi.org/10.1007/s00384-005-0742-5
  10. Birnbaum BA, Balthazar EJ. CT of appendicitis and diverticulitis. Radiol Clin North Am 1994;32:885-898.
  11. Shen SH, Chen JD, Tiu CM, et al. Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting. J Chin Med Assoc 2005; 68:411-418. https://doi.org/10.1016/S1726-4901(09)70156-X
  12. Balthazar EJ, Megibow A, Schinella RA, Gordon R. Limitations in the CT diagnosis of acute diverticulitis: comparison of CT, contrast enema, and pathologic findings in 16 patients. AJR Am J Roentgenol 1990;154:281-285. https://doi.org/10.2214/ajr.154.2.2105015
  13. Hale WB; NDSG. Colonoscopy in the diagnosis and management of diverticular disease. J Clin Gastroenterol 2008;42:1142-1144. https://doi.org/10.1097/MCG.0b013e3181862ab1
  14. Lahat A, Yanai H, Menachem Y, Avidan B, Bar-Meir S. The feasibility and risk of early colonoscopy in acute diverticulitis: a prospective controlled study. Endoscopy 2007;39:521-524. https://doi.org/10.1055/s-2007-966399
  15. Almy TP, Howell DA. Medical progress: diverticular disease of the colon. N Engl J Med 1980;302:324-331. https://doi.org/10.1056/NEJM198002073020605
  16. Penfold JC. Perforation of the colon complicating colonoscopy: report of a case. Dis Colon Rectum 1975;18:626-627. https://doi.org/10.1007/BF02587148
  17. Dean AC, Newell JP. Colonoscopy in the differential diagnosis of carcinoma from diverticulitis of the sigmoid colon. Br J Surg 1973;60:633-635. https://doi.org/10.1002/bjs.1800600814
  18. Panish JF. Limitations and complications of colonoscopy. Gastrointest Endosc 1980;26(2 Suppl):S20‐S21.
  19. Lahat A, Yanai H, Sakhnini E, Menachem Y, Bar-Meir S. Role of colonoscopy in patients with persistent acute diverticulitis. World J Gastroenterol 2008;14:2763-2766. https://doi.org/10.3748/wjg.14.2763
  20. Choi JW, Jang BI, Park YS, et al. A case of colon mucinous carcinoma mimicking diverticular disease with abscess on colonoscopy. Intestinal Research 2006;4:106-109.