Donnerstag, 19. März 2009

Wenn Dickdarmkrebs zur Verstopfung führt - Auflösung des medizinischen Rätsels...

The medical mystery in the January 22 issue (1) involved a 56-year-old woman with a medical history of scoliosis and chronic constipation who presented with shortness of breath and cough of 10 days' duration. Plain films and computed tomography (CT) of the chest revealed dilated colonic loops occupying the left hemithorax (single black arrow, Figure 1A, 1B, and 1C). The left lung was nearly completely collapsed (double black arrows, Figure 1B), and the mediastinum was significantly deviated to the right (white arrow, Figure 1A, 1B, and 1C). The patient underwent a colonoscopy, which identified a tumor in the transverse colon. She then underwent subtotal colectomy with ileosigmoid anastomosis. The operation revealed a mass, 10 cm in diameter, in the midtransverse colon, as well as eventration of the left hemidiaphragm. Histologic analysis of the mass showed mucinous adenocarcinoma. The colon was severely dilated (15 cm in diameter) from the proximal transverse to the distal sigmoid portions, with an extremely thin wall (average thickness, <0.1>
1. Karakis I, Kosmas C. A medical mystery -- constipation. N Engl J Med 2009;360:397-397

NEJM Volume 360:1259-1260 March 19, 2009 Number 12

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