ABSTRACT
Acute pseudobstruction of the large intestine is also termed the "Ogilvie" syndrome. The life- threatening condition without obvious mecha nical obstruction of the intestine, results from a major enlargement of the large intestine, which, if no therapy is initiated on time, may result in perforation of the right- sided colon, most commonly of the caecum. In this case study, the patient underwent urgent surgery for incipient caecal perforation. Nor the preoperative plain abdominal x- ray examination, abdominal CT, nor the laparotomy procedure detected any mechanical bowel obstruction. The condition was diagnosed as the Ogilvie syndrome in a chronic renal disorder of the patient. The procedure included transversostomy, drainage of the peritoneal cavity and complex management, and the patient was discharged to homecare on the ninth postoperative day. However, two weeks later, the patient was rehospitalized for bleeding from the stoma site. Colonoscopy detected a small stenosing tumor in the lienal flexure of the large intestine. The case study highlights failure of both the CT and x-ray abdominal examinations (air up to the sigmoid), as well as of the surgical exploration. Therefore, it may be concluded that not all pseudoobstructions are truely "pseudo".
Subject(s)
Colonic Pseudo-Obstruction/diagnosis , Acute Disease , Aged, 80 and over , Colonic Neoplasms/complications , Colonic Neoplasms/diagnosis , Colonic Pseudo-Obstruction/etiology , Diagnosis, Differential , Humans , MaleABSTRACT
Involvement of the gastrointestinal tract by metastases from invasive lobular carcinoma of the breast is well recognised. We report a unique case where, four years after the initial management of the primary breast disease, the patient developed colonic metastases followed by a disease-free interval of two years and then presented with gastric metastases. The patient responded successfully to first- and second-line chemotherapeutic agents on both occasions and is currently being maintained on third-line hormonal therapy.
