title: Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh.
abstract: Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39 degrees C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7 x 10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed.
authors: University of Zagreb, Zagreb University Hospital Center, Department of Surgery, Zagreb, Croatia.
authors: Branko
authors: B
authors: Bogdanić
authors: Goran
authors: G
authors: Augustin
authors: Tihomir
authors: T
authors: Kekez
authors: Davor
authors: D
authors: Mijatović
authors: Ljiljana
authors: L
authors: Hlupić
authors: Maja
authors: M
authors: Vanek
mesh_terms: D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D000038:Abscess / Q000209:etiology* / Q000601:surgery; D000368:Aged; D002763:Cholecystectomy; D002921:Cicatrix / Q000473:pathology* / Q000601:surgery; D044682:Colon, Ascending / Q000473:pathology* / Q000601:surgery; D003110:Colonic Neoplasms / Q000150:complications* / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male