Primary mesenteric adenocarcinoma covered by abscess of the mesocolon and intestinal obstruction: A case report

Abstract

Primary mesenteric adenocarcinoma (PMA) is a rare malignant disease. A case of PMA that was covered by an abscess of the mesocolon and intestinal obstruction is reported in the present study. As the onset site of PMA is often obscured or hidden, there may be no clinical symptoms in the early stage. At the advanced stage, the tumor size is large enough to induce intestinal obstruction, perforation, bleeding, volvulus and other clinical symptoms in the majority of patients. Computed tomography scans, ultrasound and other auxiliary examinations are not sufficiently accurate for diagnosing PMA with non-specific characteristics in the majority of cases, causing certain difficulties in the pre-operative diagnosis of PMA, which easily lead to misdiagnosis. The main effective treatment of PMA is surgical resection as early as possible. Thus, when a patient is suspected of having malignancies, and gastrointestinal cancer and other malignancies of the digestive organs may be excluded, the possibility of PMA should be considered.

Keywords: abscess; intestinal obstruction; primary mesenteric adenocarcinoma.

Figure 1.

Abdominal X-ray plain film showing intestinal obstruction. The splenic flexure of the colon is most clearly expanded. R, right.

Figure 2.

CT scan of the abdomen, and low-density lesions in the spleen. (A) CT image including the splenic flexure of the colon (indicated by ←), revealing the abscess of the mesocolon as an adjacent shadow (indicated by →) and an unevenly thickened bowel wall. (B) Enhanced CT scan showing a low-density lesion of the spleen on first admission. CT, computed tomography.

Figure 3.

Hematoxylin and eosin staining, showing acute gangrenous inflammation of the abscess wall of the mesocolon (magnification, ×100).

Figure 4.

CT scan of the left side of the abdomen on second admission of the patient. (A) Mesenteric adenocarcinoma was shown as an irregular soft tissue shadow (indicated by ↑) near to the left side of the superior mesenteric artery (indicated by ↓). (B) CT image on second admission, showing that the shadow on the spleen was significantly increased compared with that on first admission. CT, computed tomography.

Figure 5.

Intraoperative frozen section analysis of the mesenteric tumor during the second laparotomy, revealing poorly differentiated adenocarcinoma (hematoxylin and eosin staining; magnification, ×200).