Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5252-5258
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5252
Long-term outcome of indwelling colon observed seven years after radical resection for rectosigmoid cancer: A case report
Zi-Xuan Zhuang, Ming-Tian Wei, Xu-Yang Yang, Yang Zhang, Wen Zhuang, Zi-Qiang Wang
Zi-Xuan Zhuang, Ming-Tian Wei, Xu-Yang Yang, Yang Zhang, Wen Zhuang, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhuang ZX reviewed the literature and wrote the manuscript; Zhang Y analyzed and interpreted the imaging findings; Wang ZQ, Zhuang W, Yang XY, and Wei MT edited and revised the manuscript; all the authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and the manuscript was prepared and revised according to the CARE Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zi-Qiang Wang, MD, PhD, Chief Physician, Professor, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. wangziqiang@scu.edu.cn
Received: January 30, 2021
Peer-review started: January 30, 2021
First decision: February 25, 2021
Revised: February 28, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: July 6, 2021
Processing time: 144 Days and 23 Hours
Abstract
BACKGROUND

Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon. We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.

CASE SUMMARY

A 73-year-old male had undergone extended radical resection for rectosigmoid cancer. The invaded ileocecal area and sigmoid colon were removed during the procedure, and the ileum was anastomosed side-to-side with the rectum. The excluded ascending, transverse, and descending colon were sealed at both ends and left in the abdomen. After 7 years, the patient developed persistent abdominal pain and distension. Work-up indicated intestinal obstruction. The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained, but the symptoms persisted; therefore, surgery was planned. Intraoperatively, extensive adhesions were found in the abdominal cavity, and the small intestine and the indwelling colon were widely dilated. The dilated colon was 56 cm long, 5 cm wide (diameter), and contained about 1500 mL of viscous liquid. The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue. The bacterial culture of the secretions was negative. The patient recovered after the operation.

CONCLUSION

Although colonic exclusion is routinely performed, this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.

Keywords: Colon, Colectomy, Intestinal obstruction, Diversion colitis, Sigmoid cancer, Colitis, Case report

Core Tip: We present a case of purulent colonic necrosis in an indwelling colon that occurred 7 years after colonic exclusion. Although colonic exclusion is routinely performed for a variety of colonic diseases, indwelling colon can present with long-term complications after several years. The mechanism due to which such complications develop remains unclear, but both disuse atrophy and diversion colitis seem to play a role in their pathology. Surgeons should avoid sealing both ends of the excluded colon. We recommend continuous surveillance for an earlier detection and treatment of such complications.