Secondary intestinal perforation in the setting of abdominal wall metastasis

Abstract

A 68-year-old man presented with a five-day history of pain, redness and swelling of the right abdominal wall. He had received resection of colon cancer 1 year ago. Right abdominal wall metastasis occurred 3 months ago, which was confirmed by biopsy under ultrasound guidance. Owing to close relationship between the abdominal wall metastasis and adjacent small intestine, the patient was treated with preoperative chemotherapy and elective surgery. Abdominal X-ray examination showed pneumatosis of the right lateral abdominal wall with fluid level (Figure 1A). Water-soluble contrast gastrointestinal radiography revealed material passing from the small intestine to the right abdominal wall (Figure 1B). Subsequent computed tomography demonstrated the fistula between the abdominal wall metastasis and adjacent small intestine (Figure 1C). The patient underwent surgical resection and catheter drainage. Surgical findings confirmed an orificium fistulae in the ileum, 2 cm in diameter.