title: Distinguishing between limited systemic scleroderma-associated pseudo-obstruction and peritoneal dissemination.
abstract: A 78-year-old woman receiving treatment for limited systemic scleroderma (SSc) underwent high anterior resection and partial liver resections for rectosigmoid colon cancer with multiple liver metastases. A year after surgery, an abdominal computed tomography (CT) demonstrated suspicion for peritoneal dissemination with an increase in ascites, and (18)F-fluorodeoxy glucose-positron emission tomography-CT was suggestive of carcinomatosis. We began to decompress the small intestine and administer octreotide. However, the intestinal obstruction did not improve. Although intestinal pseudo-obstruction caused by limited SSc was considered as a differential diagnosis, we performed an exploratory laparotomy because the possibility of peritoneal dissemination-associated obstruction could not be excluded. We observed a moderate amount of serous ascites and dilatation of the small intestine that was white in color, hard, and with limited contractility. There was no evidence of peritoneal dissemination nor of mechanical obstruction. Our experience thus shows the difficulty of distinguishing SSc-associated intestinal pseudo-obstruction from peritoneal dissemination.
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. saigusa@wakabahsp.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. saigusa@wakabahsp.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Saigusa
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. yasinoue@clin.medic.mie-u.ac.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. yasinoue@clin.medic.mie-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. mohi1012@clin.medic.mie-u.ac.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. mohi1012@clin.medic.mie-u.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohi
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. ima_hirokin@yahoo.co.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. ima_hirokin@yahoo.co.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Imaoka
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. young_oh_oh_135@yahoo.co.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. young_oh_oh_135@yahoo.co.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Uratani
authors.affiliation: Department of Surgery, Wakaba Hospital, 28-13 Minami-Chuo, Tsu, Mie, 514-0832, Japan. m-koba@clin.medic.mie-u.ac.jp.|Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. m-koba@clin.medic.mie-u.ac.jp.
authors.forename: Minako
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. kusunoki@clin.medic.mie-u.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
keywords: FDG PET-CT; Limited systemic scleroderma; Peritoneal recurrence; Pseudo-obstruction