Abdominal Pain Associated with Primary Cecal Cancer
Ion Paun, Dan Mogos, Ion Vasile, Mihai Florescu, Mariana Paun,
Dan Dumitrelea & Copernicus Study Group
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.
Abdominal pain - primary cecal cancer