| Autor: |
Hamid, Mohamed, Benammi, Sarah, Bounssir, Ayoub, Bakali, Youness, Lekehal, Brahim, Hrora, Abdelmalek |
| Zdroj: |
International Journal of Surgery Case Reports; 2020, Vol. 75, p238-241, 4p |
| Abstrakt: |
• We report the clinical management challenge of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC). • Management of synchronous sigmoid cancer and abdominal aortic aneurysm requires a collegiate decision which should take into consideration the aneurysm rupture risk, the malignancy stage of tumor but also the technical platform. • In such situation, the main controversy is the necessity of treating the diseases simultaneously or in two stages favouring the AAA management first. • We report the first case published in literature in which the patient was treated for colorectal cancer first by laparoscopic surgery followed by EVAR. • Nevertheless, the surgeon must adapt his technique according to the situations, and respect the oncological and functional requirements as much as possible. The occurrence of synchronous abdominal aorta aneurysms and colorectal cancer represents a real management challenge. Up till now, there is no evidence-based consensus recommendation in the surgical management of such patients. Herein we reported the clinical management challenge of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC). 78-year-old man was admitted in our structure for acute abdominal pain, vomiting and constipation. His past medical history included type 2 diabetes, arterial hypertension and a stable infra-renal aortic aneurysm documented 2 years ago. Physical examination found a stable patient with blood pressure and heart rate within normal range, pulsatile mass along with abdominal distension with vital signs within normal limits. Abdominal CT scan and subsequent CT angiogram confirmed an 88 × 75 mm infra-renal aortic aneurysm concomitant with considerable lumen reduction due to asymmetric wall thickening of the sigmoid. Colonoscopy combined with biopsy examination confirmed structuring irregular sigmoid adenocarcinoma Therefore we report a case of a large AAA and concomitant sigmoid adenocarcinoma tumor causing stricture. In such situation, the main controversy is the necessity of treating the diseases simultaneouslor in two stages favoring the AAA management first. To our best knowledge, we report the first case published in literature in which the patient was treated for colorectal cancer first by laparoscopic surgery followed by AAA management with EVAR. In this case report, we highlight some tricks required in performing laparoscopic sigmoid colectomy for patient with large AAA to prevent per-operative pitfalls. Evidence-based consensus is required to determine the optimal surgical treatment. [ABSTRACT FROM AUTHOR] |
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