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Patient with severe kyphoscoliosis and sygmoid carcinoma - a medical challenge in an emergency setting: a case report

Objective: untreated congenital kyphoscoliosis can in adulthood lead to low back pain, osteoarthritis, spinal stenosis, different neurological and cardiopulmonary problems. It also exerts secondary effects on gastrointestinal system. Materials and methods: a 74-year- old male patient presented with symptoms of low-grade fever, constipation, tacchycardia, dyspnea and oliguria. Plain films and multi-sliced computed tomography (CT) of the chest revealed aero-liquid levels within dilated small and large intestine loops, occupying the right thoracic cavity, distended cecum up to 8.6 cm, stenotic process of the sigmoid colon and a heavy lumbar scoliosis. Due to the physical state deterioration, i.e. acute abdomen, the patient was immediately operated on. The subtotal colectomy with unipolar ileostoma was performed, due to a visible sygmoid tumorous process - later pathohistologically confirmed as adenocarcinoma. The primary suspicion of a huge diaphragmatic hernia, was later eliminated during surgery and by finding out the patient's history of long-running, surgically untreated severe kyphoscoliosis, which affected a position of the thoracic viscera, further worsened by stenotic colonic process that lead to dilated and shifted bowel loops. Results: patient was discharged on the 14th postoperative day, returning on the regular follow-up two months later. Due to severe kyphoscoliosis and the resulting concavity of abdominal wall, the stomal bag didn't adhere well to the abdominal wall. The result was a peristomal dermatitis caused by a leaking bowel content. Conclusion: this case presents a medical challenge, especially when the primary diagnosis wasn't completely obvious. Although we noticed an irregular patient's posture, we were initally mislead and believed that bowel loops herniated diaphragmatic muscle. After the surgical verification of colonic carcinoma, it was obvious that dilated bowel loops only shifted diaphragmatic muscle. Unfortunately, heavy vertebral pathology disqualified our patient from a possible second surgery, which would include ileostomy closure.

severe kyphoscoliosis ; acute abdomen ; sygmoid carcinoma

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