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Abstract: A 74-year-old female patient reported pain in the lower abdomen for 1 year, with paroxysmal vague pain, which was ignored at that time, but recently the discomfort became worse, accompanied by symptoms of shortness of breath and weakness, so she came to the hospital for help, and the comprehensive examination results led to the diagnosis of colon cancer, which was treated with surgery as well as medication.
Basic information】Female, 74 years old
Disease Type】Colon cancer (sigmoid colon cancer)
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】April 2022
Treatment plan】Surgery (radical sigmoid colon cancer surgery) + intravenous drugs (irinotecan hydrochloride for injection, cefradine for injection)
Treatment period】28 days of in-hospital treatment, 10 days after discharge for review
Treatment effect] The disease was controlled and the abdominal discomfort disappeared.
I. Initial consultation
The patient complained of pain and discomfort in the lower abdomen with no obvious cause, paroxysmal vague pain, accompanied by frequent urination, urinary urgency, painful urination, urine like washing water, no treatment, abdominal pain worsened, 1-2 times/day of stool, gradually emergence of urgency, thin stool, no flesh-eye blood, stool with mucus, urine color as stool, accompanied by weakness, feeling symptoms gradually aggravated, recent weight loss of about 20 kg. We learned that the patient had a history of hypertension and usually took medication regularly. On examination, a solid mass of about 13 cm in size was palpated in the lower abdomen, with obvious pressure pain and slightly poor mobility. After the completion of CT, the patient’s sigmoid colon wall was significantly thickened, involving the left side of the bladder wall, which was consistent with malignant tumor.
II. Treatment process
I first told the patient that the diagnosis of sigmoid colon cancer had been confirmed and the cancer cells had spread to the bladder, so surgery and medication should be taken in time, otherwise the cancer cells would continue to spread to distant places, which would make the treatment of the disease more difficult and even endanger the patient’s life. Under local anesthesia, radical surgery for sigmoid colon cancer was performed, during which sigmoid colon cancer resection, transverse colostomy, partial cystectomy, cystostomy, appendectomy and left ureteral D-J tube implantation were completed, and the operation went smoothly. Cefradine for injection was given to prevent infection, and irinotecan hydrochloride for injection was also prescribed to prevent the cancer cells from re-growing or spreading to distant areas through chemotherapy.
III. Treatment effect
On the 1st day after surgery, the patient’s body temperature was 36.8℃, no fever was observed, and her mental status was still acceptable. On the second day after surgery, the patient’s drainage tube was clear, and the symptoms of lower abdominal pain, shortness of breath, mucus stool and weakness had improved, and there were no other abnormalities. On the 28th postoperative day, the discomfort disappeared, and the patient did not have fever and chills, nausea and vomiting, panic and chest tightness, etc., and the discharge from the stoma was possible. On examination, the patient’s abdomen was flat and soft, with no pressure pain or rebound pain, and he could urinate on his own, so his condition was controlled and he was discharged. The patient’s condition was controlled and he was discharged. 10 days after discharge, he was reviewed by the doctor and no other adverse conditions were observed.
IV. Precautions
I am also happy that the patient can be discharged normally, but I still suggest that the patient should pay attention to the following points at the time of discharge.
1, should do a good job of cystostomy care, to ensure that the surrounding skin is dry and clean, to avoid cystostomy tube prolapse, and should also be clamped closed cystostomy tube on time.
2, usually try to avoid eating a lot of spicy, greasy diet, should be appropriate to eat more radish, cabbage, bananas and other high-fiber foods, and appropriate activities to ensure smooth bowel movements, do not sit for a long time, standing.
3. In addition, if there are obvious adverse symptoms during the period of taking anti-infective drugs or chemotherapy, you should promptly seek medical advice from me.
V. Personal insight
Colon cancer is a malignant tumor with a fast progression, which is more likely to infiltrate into the surrounding and more distant tissues and organs, thus endangering the life of patients. In this case, the 74-year-old female patient did not care about her lower abdominal paroxysmal vague pain at the beginning, which delayed the treatment of the disease and made the cancer cells infiltrate into the bladder, which aggravated the patient’s discomfort and made the treatment more difficult. Therefore, it is recommended to seek medical treatment promptly if you find any abnormal phenomenon that cannot be relieved.