Abstract
A 78-year-old woman receiving treatment for limited systemic scleroderma (SSc) underwent high anterior resection and partial liver resections for rectosigmoid colon cancer with multiple liver metastases. A year after surgery, an abdominal computed tomography (CT) demonstrated suspicion for peritoneal dissemination with an increase in ascites, and 18F-fluorodeoxy glucose-positron emission tomography-CT was suggestive of carcinomatosis. We began to decompress the small intestine and administer octreotide. However, the intestinal obstruction did not improve. Although intestinal pseudo-obstruction caused by limited SSc was considered as a differential diagnosis, we performed an exploratory laparotomy because the possibility of peritoneal dissemination-associated obstruction could not be excluded. We observed a moderate amount of serous ascites and dilatation of the small intestine that was white in color, hard, and with limited contractility. There was no evidence of peritoneal dissemination nor of mechanical obstruction. Our experience thus shows the difficulty of distinguishing SSc-associated intestinal pseudo-obstruction from peritoneal dissemination.
Highlights
Intestinal pseudo-obstruction is caused by several diseases including connective tissue disorders, hypothyroidism, Chagas’ disease, diabetes, and Parkinson’s disease
We report a case in which it was difficult to distinguish between SScassociated pseudo-obstruction and peritoneal dissemination in a Systemic scleroderma (SSc) patient after surgery for stage IV colon cancer
Limited SSc is a subtype of systemic scleroderma that was previously referred to as CREST syndrome
Summary
Intestinal pseudo-obstruction is caused by several diseases including connective tissue disorders, hypothyroidism, Chagas’ disease, diabetes, and Parkinson’s disease. Systemic scleroderma (SSc) is a chronic disorder of the connective tissue characterized by inflammation, fibrosis, and degeneration of the skin and blood vessels and is known to cause intestinal pseudoobstruction [1,2,3,4,5]. The radiographic findings of intestinal pseudo-obstruction caused by SSc are a hide-bound bowel sign or accordion sign on abdominal X-ray or contrast study and pneumatosis cystoides intestinalis on abdominal computed tomography (CT) [3,6,7,8].
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