腸閉塞で発症した腹膜播種を伴う前立腺癌

Ileus as the first sign of prostate cancer with peritoneal dissemination : A case report

　68歳男性．腹部膨満感と嘔気で受診．CTで150mm大の骨盤内腫瘍と腸管ガス貯留を認めたが，大腸内視鏡では下行結腸まで閉塞を認めず．原因不明の腸閉塞に対して手術を施行し，上行結腸の播種性病変による閉塞を認め，回腸末端人工肛門造設術と腫瘍，大網生検術を施行した．ともに前立腺癌を認め，ホルモン療法を開始，PSAは著明低下し，骨盤内腫瘍と播種性病変はともに縮小した．結腸の通過障害は改善し人工肛門閉鎖術を施行し，排便機能は回復した．

Abstract

A 68-year-old man was admitted to our hospital with complaining of abdominal fullness and nausea. Fiber colonoscopy revealed no obstruction in the descending colon, and CT showed massive bowel gas, a huge intrapelvic tumor, enlarged retroperitoneal lymph nodes, multiple nodules in the pleura and peritoneum, and soft tissue densities near the ascending and descending colons. A diagnosis of ileus due to unknown cause was made. We performed an ileum colostomy and found multiple intraperitoneal disseminations and stenosis of the ascending colon. Pathological examination showed prostate cancer with both intrapelvic tumors and peritoneal metastases. The patient started treatment with combined androgen blockade when PSA level was 1635ng/mL; PSA level decreased to 0.63 in 3 months, and tumor nodule dimensions were markedly reduced. After the confirmation of bowel obstruction release, the patient underwent closure of ileum colostomy and bowel function was restored (Rinsho Hinyokika 75: 351-354, 2021).