RESUMO
Colorectal schwannomas are rare and usually benign gastrointestinal mesenchymal tumors. However, these tumors are often overtreated, possibly owing to misleading malignant potential. To our knowledge, there have been no previous reports of ascending colon schwannoma preoperatively diagnosed as benign schwannoma. Herein, we report a case of ascending colon schwannoma accurately diagnosed by endoscopic biopsy and successfully treated by wedge resection. The patient was a 76-year-old woman with complaints of bloody stool. She had no relevant past medical history. Radiological findings revealed a protruded mass in the ascending colon, and colonoscopy revealed a submucosal tumor measuring approximately 3 cm in diameter with a reddish and uneven surface. Histological and immunohistochemical analysis for vimentin and S100 protein of the specimen obtained by endoscopic biopsy confirmed the diagnosis of schwannoma. Thus, we performed laparoscopy-assisted endoscopic full-thickness resection of the ascending colon wall, as appropriate for a benign soft tissue tumor. The postoperative course has been uneventful for 2 years. This case demonstrates that colonic schwannoma can be successfully treated with adequate resection if an accurate preoperative diagnosis is made, thereby avoiding overtreatment, such as surgery for colorectal tumor including lymph node dissection. Preoperatively diagnosed schwannomas should be treated by wedge resection, with postoperative pathological findings confirming the presence or absence of malignancy. Additional resection should be considered for very rare cases of coexisting malignant tissue.
RESUMO
A case of silent perforated diverticulitis in the ascending colon combined with pylephlebitis, resulting in complete occlusion of the portal trunk, is presented. A 75-year-old man with no relevant medical history visited our hospital complaining of a fever, which had lasted for 2 weeks. Although his laboratory data were indicative of severe inflammation, an abdominal examination and a computed tomography (CT) scan did not produce any significant findings. On the 6th day after admission, an abdominal CT scan detected a thrombus extending from the superior mesenteric vein to the portal vein, but did not show any signs of infection. However, on the 40th day after admission, an abdominal CT scan detected an embolus in the portal vein completely occluding the main portal trunk, as well as marked edematous changes indicative of inflammation, and an abscess in the ascending colon. We performed laparotomy and iliocecal resection, during which a perforation of the ascending colon derived from diverticulitis was found. We report this rare case and a review of the literature.
