Colorectal cancer (CRC) can occasionally coexist with diverticulitis, thereby complicating diagnosis and treatment. In cases of refractory diverticulitis, it is important to consider the possibility ...of malignancy and determine appropriate treatment strategies. An 85-year-old male presented with lower left abdominal pain; he was admitted for further examination and the treatment of suspected sigmoid diverticulitis. On examination, a firm mass was palpated in the lower left quadrant. Imaging revealed sigmoid diverticulitis, partial abscess formation, and the involvement of the small bowel and abdominal wall. Although malignancy was suspected, a definitive diagnosis was not made. Because of the refractory nature of the disease, early surgical intervention, sigmoid colectomy, partial small bowel resection, abdominal wall resection, and lymph node dissection, was performed in accordance with the malignancy protocol. Pathologic diagnosis revealed adenocarcinoma within the diverticulitis with negative resection margins, indicating curative surgery. The low preoperative diagnostic rate of CRC associated with diverticulitis highlights the need for vigilance. Refractory diverticulitis may indicate the presence of concealed malignancy requiring surgical intervention. In the management of refractory diverticulitis, it is important to consider the potential coexistence of cancer. Even if extensive investigations are performed and a definitive diagnosis remains elusive, surgery must be considered.
A 75-year-old male complaining of back pain was admitted to our hospital. Abdominal computed tomography and ultrasonography showed dilatation of the main pancreatic duct. Duodenoscopy revealed a ...tumor of about 15mm in diameter at the papilla of Vater and a biopsy examination of the tumor revealed adenoma. Endoscopic retrograde pancreatography showed irregularity and dilatation of the main pancreatic duct from the head to the tail without apparent stenosis of the papilla of Vater. Endoscopic ultrasonography showed a hypoechoic mass of about 15mm in diameter at the papilla of Vater, and suspected partial invasion into the proper muscle of the duodenum. Since the preoperative diagnosis was considered as adenoma of the papilla of Vater with chronic pancreatitis, pancreaticoduodenectomy was performed. Pathological examination of the resected specimen demonstrated adenomacarcinoma existing partly in adenoma of the papilla of Vater with a remarkable spread of adenoma along the main pancreatic duct, which extended to the surgical margin of the pancreas. This case report suggests that there are some adenomas of the papilla of Vater which spread remarkably along the pancreatic duct. Therefore, we should perform adequate examinations such as intraductal ultrasonography and pancreatoscopy for the diagnosis of tumor infiltration in the pancreatic duct before surgery, which can be useful for selecting the treatment.
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