A radical resection of the descending colon and abdominal wall successfully reconstructed using a latissimus dorsi musculocutaneous flap

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 74; no. 1; pp. 129 - 136
• Main Authors: YAMAGISHI, Yota, KOMORI, Tetsuya, SUMITA, Naoki, HORI, Keiichi, MURAMOTO, Masayuki, TAKEICHI, Yumeji
• Format: Journal Article
• Language: Japanese; English
• Published: Japan Surgical Association 2013
• Subjects: abdominal wall abscess; colon cancer
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.74.129

A 37-year-old woman with left lateral abdominal pain was found on computed tomography (CT) to have an abdominal wall abscess abutted by a fist-sized tumor of the descending colon. Based on a preoperative diagnosis of abdominal wall abscess (due to carcinoma of the descending colon infiltrating to the abdominal wall) , we conducted emergency surgery to perform abscess drainage and transverse colon loop colostomy. The drained pus and tissues were sent to pathology and showed moderate- to well-differentiated adenocarcinoma. After the patient's general condition improved and the acute inflammation subsided, we performed Hartmann's operation with D3 lymphadenectomy. We also performed en bloc excision of the full thickness of the anterior abdominal wall, including the abscess, accompanied by reconstruction of the large spindle-shaped abdominal wall defect (20 × 10 cm) using a latissimus dorsi musculocutaneous flap (LDMF) . Pathology showed moderate- to well-differentiated adenocarcinoma : pS1, pN2, ly1, v0, RM0, and fStage IIIb. The adenocarcinoma had directly invaded near the skeletal muscle of the abdominal wall. Plastic reconstructive surgery of the abdominal wall defect with a musculocutaneous flap enabled us to perform a complete radical resection of the colon cancer that produced an abdominal wall abscess.