A case of peritoneal dissemination with rectal stenosis 5 years and 6 months after the surgery of breast cancer

乳癌術後5年目に直腸狭窄を伴う癌性腹膜炎を発症した1例を経験した.症例は60歳,女性.5年6ヵ月前に左乳癌で根治術が施行された.今回,排便困難で受診し,諸検査で直腸狭窄・両側水腎症を認め,癌性腹膜炎や後腹膜線維症が疑われたが鑑別は困難であった.開腹術を施行したところ,腹膜や大網に多数の微細結節を認め,これらの結節を採取し回腸末端に人工肛門を造設した.病理検査で乳癌の癌性腹膜炎と確定診断された.術後第12病日目に軽快退院し現在外来でEC療法を継続して経過観察中である.若干の文献的考察を加えて報告する.

We described a patient with carcinomatous peritonitis and rectal stenosis that developed 5 years after surgery for breast cancer. The 60-year-old patient had undergone a radical mastectomy for breast cancer 5 years before. She visited to our hospital because of difficulty with defecation, and underwent extensive examinations. She was diagnosed as having rectal stenosis and bilateral hydoronephrosis.Carcinomatous peritonitis or retroperitoneal fibrosis was suspected but differential diagnosis was difficult. We performed laparotomy and a large number of granules were evident macroscopically in the greater omentum and mesenterium. Some pieces of these granuler tissues were biopsied and a double-barrelled ileostomy was created. The patient was diagnosed histologically as having carcinomatous peritonitis. She was discharged from the hospital 12 days after surgery, and has been followed up for continuation of EC therapy in the outpatient department. We report the case with a review of the literature.

再発乳癌

癌性腹膜炎

特発性後腹膜線維症