PMC9445364_01
(A). Plain abdominal radiograph showing intestinal obstruction. (B, C) Abdominal CT illustrating colon cancer causing obstruction (June 2019).
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A diagnosis of bowel obstruction caused by sigmoid colon tumor was made ( Figure 1 ).
(A) Colonoscopy showing a tumor (June 2019). (B) Colonoscopy showing a stent placed to prevent obstruction (July 2019).
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Colonoscopy revealed moderately differentiated adenocarcinoma ( Figure 2A ). On July 2019, endoscopic SEMS was performed ( Figure 2B ).
(A) Abdominal plain radiograph showing the duodenal obstruction. (B, C) Abdominal CT demonstrating a tumor invading the duodenum and causing duodenal obstruction due to compression (January 2022).
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CT revealed a sigmoid carcinoma infiltrating upper jejunum and gastroduodenal retention ( Figure 3 ). Colonoscopy showed that the SEMS was blocked preventing entry of endoscope ( Figure 4A ).
(A) Colonoscopy indicating stent tumor necrosis. (B) Gastroscopy showing a tumor invading the duodenum (January 2022). (C) Intraoperative tumor (The jejunum and duodenum are severely affected). (D) Postoperative tumor incision specimen (February 28, 2022). (E) Timeline of the relevant treatments.
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CT revealed a sigmoid carcinoma infiltrating upper jejunum and gastroduodenal retention ( Figure 3 ). Colonoscopy showed that the SEMS was blocked preventing entry of endoscope ( Figure 4A ). Gastroscopy revealed a mass blocking the bowel in the horizontal segment of the duodenum, and pathological biopsy confirmed a diagnosis of adenocarcinoma ( Figure 4B ). Although most physicians recommend palliative surgery (bypass surgery) based on the patient's age and underlying disease, we suggested radical resection on 2022-2-28 as follows sigmoid colectomy + lymph node dissection + partial resection of duodenum and upper jejunum + duodenojejunostomy + descending colostomy ( Figures 4C, D ). A timeline diagram of the relevant treatments is shown in  Figure 4E .