Acute Abdominal Pain Associated with Primary Cecal Cancer

Ion Paun, Dan Mogos, Ion Vasile, Mihai Florescu, Mariana Paun, Dan Dumitrelea & Copernicus Study Group

Abstract

Objective. Our aim was to investigate the problems of diagnosis and management raised by primary cecal cancer patients with acute abdominal pain as their main symptom.

Study design
. We reviewed records and histopathology slides of 246 patients with malignant neoplasm of the colon diagnosed and treated in our clinic from 1980 to 1996.
Sixteen of the 246 patients (6.5%) had acute abdominal pain as the presenting symptom of cecal malignancies (100% adenocarcinomas) complicated by peritumoral inflam-mation (5 patients) or acute obstruction (2 patients) and/or perforations (9 patients).
Thirteen patients (97.3%) underwent the standard right hemicolectomy with the total excision of the involved lymphatics and bowel continuity reconstruction. In 3 high-risk patients with multiple hepatic and peritoneal metastases or local advanced cancer, ileotransverse anasto-mosis was performed.

Results
. The postoperative morbidity consisted of 3 wound infections (18.8%) and 1 ileocolonoanastomosis dehiscence with generalized peritonitis which was also responsible for a mortality rate of 6.2% (1 patient). The differential diagnosis of the acute abdominal pain in our series required flexible pre-, intra- and postoperative investigations.

Conclusions
. The diagnosis of acute abdominal pain complicating cecal malignancies requires a high index of suspicion and a dilligent follow-up of symptoms and signs, especially in high-risk patients. The resectional management was the treatment of choice in the vast majority of compli-cated cecal cancer patients in our series.

Key words


Abdominal pain - primary cecal cancer