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Abstract: The patient presented with a thyroid nodule found during a physical examination. When completing the relevant tests, he was found to have positive routine occult blood in the stool and was considered to have gastrointestinal bleeding. Since sigmoid adenocarcinoma was more urgent than thyroid nodule, treatment of sigmoid adenocarcinoma was recommended first, and the patient agreed. Through surgery and chemotherapy, the patient’s sigmoid colon adenocarcinoma was successfully resected, and no tumor recurrence was detected during the follow-up.
Basic information】Male, 66 years old
Disease Type】Sigmoid colon adenocarcinoma
Hospital】The Fourth Hospital of China Medical University
Date of consultation】November 2021
Treatment plan】Surgery (radical laparoscopic sigmoid colon adenocarcinoma) + drug therapy (injectable cefmenoxime hydrochloride, along with glucose sodium chloride injection, fatty milk amino acid (18) injection, potassium chloride injection) + gastrointestinal decompression + pneumatic therapy + chemotherapy (injectable oxaliplatin, capecitabine tablets)
[Treatment cycle] 2 weeks in hospital, 1 month postoperative review to start chemotherapy
Treatment effect] The tumor was successfully removed intraoperatively, and no sign of tumor recurrence was found during the follow-up.
I. Initial consultation
The patient was seen for physical examination of thyroid nodules with TI-RADS classification of grade 4a, without hyperthyroidism such as hyperphagia, palpitations, weight loss, insomnia, fear of heat, excessive sweating, etc. The patient had a 6%-11% chance of malignancy, but the patient had no clinical symptoms related to it. Physical and chemical tests showed normal blood, liver and kidney functions, blood glucose, seven normal nail function tests, normal tumor markers, but positive occult blood in stool, and no occupying lesions in chest and abdominal CT. Considering the possibility of gastrointestinal bleeding, the patient underwent gastroscopy, which revealed the possibility of non-atrophic gastritis and sigmoid colon cancer, and the pathological result confirmed the diagnosis of sigmoid colon adenocarcinoma. The patient was asked about his past medical history and complained of frequent abdominal discomfort and weakness.
Treatment history
Sigmoid colon adenocarcinoma is clearly diagnosed as a malignant tumor of the sigmoid colon, which needs to be addressed as a priority compared with thyroid nodules, otherwise treatment is easily delayed and distant metastases such as liver and lung are likely to occur, missing the best time for treatment and endangering life. After full communication with the family and the patient and obtaining consent, laparoscopic radical resection of sigmoid colon adenocarcinoma was performed under general anesthesia. The patient required postoperative water fasting, gastrointestinal decompression, cardiac monitoring, pneumatic therapy to prevent deep vein thrombosis in the lower extremities, intravenous cefmenoxime hydrochloride for injection, and rehydration with glucose sodium chloride injection, fatty milk amino acid (18) injection, and potassium chloride injection. The patient was discharged after 2 weeks of hospitalization and instructed to review 1 month after surgery and start chemotherapy with the regimen of injectable oxaliplatin and oral capecitabine tablets.
III. Treatment results
The tumor was successfully removed during the operation, and the patient recovered well after the operation without inflammation and intestinal obstruction such as fever, abdominal pain, abdominal distention. After 1 week postoperatively, the patient ate clear liquid food, gradually transitioned to semi-liquid food, reduced fluid input, stopped the use of antibiotics, normal blood routine and liver and kidney function on re-examination, no fluid and mass on abdominal CT, the abdominal drainage tube was removed, the incision was dismantled and the patient was discharged. No sign of tumor recurrence was found during the follow-up.
IV. Notes
We are glad that the patient was clinically cured after treatment, but we still advise her to pay attention to her diet structure and avoid cold, spicy and sticky foods to prevent abdominal pain, abdominal distension and even intestinal obstruction. At the same time, strengthen nutrition, eat less and more meals, especially more protein foods to improve their immunity. Patients should adjust their mindset, cope with bad emotions, face the disease correctly and establish confidence to overcome the disease. Follow the doctor’s orders for review so that problems can be detected and dealt with in a timely manner.
V. Personal insight
In this case, the patient visited the clinic because of thyroid disease, and there were no obvious symptoms of intestinal obstruction such as abdominal pain, abdominal distension, exhaustion and difficulty in defecation, and there were no manifestations of left hemicolectasis such as frequent stools, pus and blood stools, urgency and heaviness, so it was easy to ignore the existence of colonic disease. Fortunately, when perfecting the examination, positive fecal occult blood was found in time, and sigmoid colon adenocarcinoma was discovered through colonoscopy and timely radical surgery was performed. The incidence of intestinal malignant tumors has been increasing in recent years and is getting younger and younger, but the specific causes of the disease are still unknown. Theoretically, it is related to colon polyps, especially colonic villous adenoma-like polyps, ulcerative colitis, genetic factors, and frequent consumption of barbecue and pickled, high-salt and high-protein foods, which are difficult to prevent in daily life, so medical checkups are very important, and all people aged >40 should actively undergo Gastroscopy should be actively performed at the age of >40 years to detect lesions in time and improve the prognosis.