A CASE OF INTRAABDOMINAL INFLAMMATORY TUMOR CAUSED BY PERFORATION OF THE TRANSVERSE COLON DUETO A FISH BONE WHICH WAS PREOPERATIVELY DIAGNOSED

We sucessfully diagnosed a tumor of the abdominal wall of unknown origin existing over 10 years as intraabdominal inflammatory tumor caused by perforation of the transverse colon due to a fish bone before surgery. This paper describes the case with some pathological consideration and a review of the literature. A 74-year-old man was seen at the hospital because of abdominal pain, when a tumor with tenderness was palpated in the left upper portion of the navel. On blood chemical study, increases in the white blood cell count of 14, 300mm3 and CRP of 17mg/dl were noted. Abdominal CT and ultrasonography revealed a tumor shadow about 5cm in diameter with a linear high density center which was the same location as tenderness was felt. Barium enema study revealed a poorly extending portion in the middle of the transverse colon. Colonoscopy disclosed swelling of folds in mucosa of the transverse colon and redness just beneath the tumor. From these findings and a fact that the patient had a preference for fish, he was operated on with a diagnosis of intraabdominal inflammatory tumor caused by perforation of the transverse colon due to a fish bone. It was found out that a tumor was formed in the greater omentum and adhered to the transverse colon, jejunum and abdominal wall. A fish bone about 2.5cm in length was confirmed in the tumor. It is thought that an intraabdominal foreign body should be entertained as a probable diagnosis when we encounter intraabdominal tumors of unknown cause.