ABSTRACT
INTRODUCTION: We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer. PRESENTATION OF CASE: The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis. DISCUSSION: This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections. CONCLUSION: This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries.
ABSTRACT
INTRODUCTION: Cancer arising from the stoma is relatively rare. There is no established surgical procedure for stomal cancer. Furthermore, when a subcutaneous lymphovascular invasion occurs, there is no consensus on whether lymph node dissection along the lymph flow is required. We diagnosed colorectal cancer 20 years after radical resection of rectal cancer. PRESENTATION OF CASE: We encountered a 70-year-old man who had undergone Hartmann's procedure for rectal cancer 20 years before consultation. Colonoscopy revealed a 30-mm-sized sub-pedunculated polyp with a base at the stoma, and a well-differentiated adenocarcinoma was detected. Approximately 30 mm of the intestinal tract, including the stoma and skin in contact with the tumor, was resected. Pathological examination revealed submucosal invasive cancer with infiltration into the resected skin dermis and invasion of lymphatic vessels under the mucosa. Surgical margins were negative. DISCUSSION: It is thought that several causes overlap for stomal cancer, although a clear cause of occurrence is yet to be identified. However, as no established surgical procedure exists, the necessity for resection of the lymph nodes without exposure appears indisputable. Although it was reported that skin or subcutaneous metastasis in colorectal cancer is generally regarded as a symptom of systemic metastasis, opinions on the subcutaneous dissection margin of stomal cancer are rarely discussed. CONCLUSION: Stomal cancer can be observed macroscopically without colonoscopy. Patients and staff engaged in stoma care should be fully aware that continuous observation of the stoma is necessary even after rectal cancer surveillance is complete.
ABSTRACT
The patient was a sixty-five-year-old man who had an advanced rectal cancer (Ra, type 2) with liver metastases. Low anterior resection with lymphnode dissection (D3) was done, but hepatectomy was not performed because of the multiple metastases besides the five tumors detected preoperatively. The pathological finding was moderately-differentiated adenocarcinoma. He was treated with 5-FU via the hepatic artery, but the therapy failed due to catheter infection after 3 postoperative months. Then, he received general 5-FU/l-LV therapy intravenously from 3 to 8 months after the operation, and oral UFT/LV (Uzel®) from 9 to 22 months. Next, we switched to single UFT therapy at 23 months because CT findings showed remarkable calcification in the liver metastases. But only one tumor of the liver (S6) among liver metastases enlarged at 27 months. We switched the chemotherapy again to UFT/Uzel and mFOLFOX6, but decided to perform hepatectomy of S6/7 at 39 months since it proved ineffective. The pathological finding was 90% necrosis and calcification of the tumor. Metastasis of the right 10th rib was newly found and was removed at 63 months after the first operation. Now, NC in the liver is continued 67 months after the first operation, and the patient is doing well.
