title: [Damage Control Surgery for Perforation of Colon Cancer].
abstract: Perforation due to colon cancer maycause peritonitis and septic shock. In these cases, we maynot be able to rescue the patients in spite of emergencysurgical intervention; in these conditions, owing to limitations of operation time, it is difficult for us to assess the state or extent of the disease and to perform an ideal oncological surgerywith dissection of lymph nodes. To overcome these limitations, we introduce the concept of "damage control surgery" developed in the trauma region to treat perforations of colon cancer. There are 3 steps: first, the perforated intestine is resected and the peritoneal cavityis lavaged to control contamination. Open abdominal management is used as a temporaryabdominal closure; second, sepsis is treated in the ICU; and third, based on the treatment strategydecided upon after consulting a colorectal surgeon and the patient's family, a colostomy, anastomosis, and extra dissection of lymph node are performed before abdominal closure. We report the fatal case of a 92-year-old woman who had developed severe shock to indicate the significance of this strategy.
authors.affiliation: Dept. of Acute Care Surgery, Sakai City Medical Center.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ebihara
authors.forename: Motohiko
authors.initials: M
authors.lastname: Yamada
authors.forename: Katsushu
authors.initials: K
authors.lastname: Simizu
authors.forename: Koji
authors.initials: K
authors.lastname: Amano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawada
authors.forename: Genta
authors.initials: G
authors.lastname: Sawada
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsunetoshi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakata
authors.forename: Akihiro
authors.initials: A
authors.lastname: Usui
authors.forename: Masaki
authors.initials: M
authors.lastname: Tujie
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Satoru
authors.initials: S
authors.lastname: Munakata
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Nakata
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome