Right Colon Tumor Caused Lower Gastrointestinal Massive Bleeding

Yıl 2022, Cilt: 2 Sayı: 1, 32 - 37, 03.04.2022

Tolga Kalaycı , Turgut Anuk

https://doi.org/10.29228/HMJ.12

Öz

Colon cancer is a major health problem all over the world. Colon cancer can be diagnosed with an elective diagnosis as well as during emergencies such as perforation, obstruction or bleeding. Tumor-related bleeding is usually seen in right colon tumors, while left colon tumors usually present with obstructive symptoms. In this case report, it is aimed to present the diagnosis and treatment process of massive lower gastrointestinal bleeding caused by a giant right colon tumor. A 57-year-old male was admitted to general surgery clinic with lower gastrointestinal massive bleeding. He had hypotension, tachycardia and lower hemoglobin level (5.4 g/dL). He became hemodynamically stable after intravenous fluid replacement and blood product transfusion. After evaluation with colonoscopy and computed tomography, he had resectable giant right colon tumor. Emergency right hemicolectomy with anastomosis was performed. He was discharged on the 6th postoperative day. Pathology of the operation material was consistent with adenocarcinoma. The tumor dimensions were 120*80*25 mm. Surgical border was negative and there was a metastatic lymph node with 49 reactive lymph node.

Anahtar Kelimeler

Colon tumor, gastrointestinal bleeding, hemodynamic shock.

Right Colon Tumor Caused Lower Gastrointestinal Massive Bleeding

Öz

Kolon kanseri tüm dünyada önemli bir sağlık sorunudur. Kolon kanseri, elektif bir tanı ile teşhis edilebileceği gibi, perforasyon, tıkanıklık veya kanama gibi acil durumlarda da konulabilir. Tümöre bağlı kanamalar genellikle sağ kolon tümörlerinde görülürken, sol kolon tümörleri genellikle obstrüktif semptomlarla karşımıza çıkar. Bu olgu sunumunda dev bir sağ kolon tümörünün neden olduğu masif alt gastrointestinal sistem kanamasının tanı ve tedavi sürecinin sunulması amaçlanmıştır. 57 yaşında erkek hasta alt gastrointestinal masif kanama ile genel cerrahi polikliniğine başvurdu. Hipotansiyon, taşikardi ve düşük hemoglobin (5,4 g/dL) vardı. Hasta intravenöz sıvı replasmanı ve kan ürünü transfüzyonundan sonra hemodinamik olarak stabil hale geldi. Kolonoskopi ve bilgisayarlı tomografi ile değerlendirildikten sonra hastada rezektabl dev sağ kolon tümörü mevcuttu. Anastomoz ile birlikte acil sağ hemikolektomi yapıldı. Postoperatif 6. günde hasta taburcu edildi. Ameliyat materyalinin patolojisi adenokarsinom ile uyumluydu. Tümör boyutları 120*80*25 mm idi. Cerrahi sınır negatif, 1 metastatik lenf nodu ve 49 reaktif lenf nodu mevcuttu.

Anahtar Kelimeler

Kolon tümörü, gastrointestinal kanama, hemodinamik şok.

Kaynakça

• Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA: A Cancer Journal for Clinicians. 2021;71(1):7-33.
• https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf (Access time: 01/01/2022).
• Gainant A. Emergency management of acute colonic cancer obstruction. Journal of visceral surgery. 2012;149(1):e3-e10.
• Yang X-F, Pan K. Diagnosis and management of acute complications in patients with colon cancer: bleeding, obstruction, and perforation. Chinese Journal of Cancer Research. 2014;26(3):331.
• Hur S, Jae HJ, Lee M, Kim H-C, Chung JW. Safety and efficacy of transcatheter arterial embolization for lower gastrointestinal bleeding: a single-center experience with 112 patients. Journal of Vascular and Interventional Radiology. 2014;25(1):10-9.
• Ghassemi KA, Jensen DM. Lower GI bleeding: epidemiology and management. Current gastroenterology reports. 2013;15(7):333.
• Federica G, de’Angelis Nicola KS, Marco M, di Mario Francesco LG, Alessia G, Fabiola F, et al. Clinical approach to the patient with acute gastrointestinal bleeding. Acta Bio Medica: Atenei Parmensis. 2018;89(Suppl 8):12.
• Ray-Offor E, Elenwo SN. Endoscopic Evaluation of Upper and Lower Gastro‑Intestinal Bleeding. Nigerian Journal of Surgery. 2015;21(2):106-10.
• Strate LL. Lower GI bleeding: epidemiology and diagnosis. Gastroenterology Clinics. 2005;34(4):643-64.
• Gençosmanoğlu R, İnceoğlu R. Diagnosis and treatment of acute lower gastrointestinal bleeding. Marmara Medical Journal. 2001;14(2):119-30.
• Kim BSM, Li BT, Engel A, Samra JS, Clarke S, Norton ID, et al. Diagnosis of gastrointestinal bleeding: A practical guide for clinicians. World journal of gastrointestinal pathophysiology. 2014;5(4):467.
• DiGregorio AM, Alvey H. Gastrointestinal Bleeding. StatPearls [Internet]. 2020 (Access time: 01/01/2022).
• Aghighi M, Taherian M, Sharma A. Angiodysplasia. 2019.
• Strate LL, Gralnek IM. Management of patients with acute lower gastrointestinal bleeding. The American journal of gastroenterology. 2016;111(4):459.
• Moss AJ, Tuffaha H, Malik A. Lower GI bleeding: a review of current management, controversies and advances. International journal of colorectal disease. 2016;31(2):175-88.
• Marion Y, Lebreton G, Le Pennec V, Hourna E, Viennot S, Alves A. The management of lower gastrointestinal bleeding. Journal of visceral surgery. 2014;151(3):191-201.
• Raphaeli T, Menon R. Current treatment of lower gastrointestinal hemorrhage. Clinics in colon and rectal surgery. 2012;25(04):219-27.