図３〜図７の上行結腸後壁の↑が癌病変で，そこから口側の上行結腸と盲腸が軽度拡張しており腸閉塞である．図３〜図１１の▲は腸管外遊離ガスで，図４〜図７の△は液貯留と遊離ガスを示しているから大腸閉塞に伴う右側結腸の穿孔と診断する．回腸末端（TI）に拡張はなく小腸はわずかに拡張しているだけであることが穿孔の要因になったと思われる．CT所見が正確に読み取られず，翌日の腹部エコー検査で腹水の増加を認め手術となった．癌病変より口側で，Bauhin弁近辺の盲腸前壁３ヶ所に穿孔を認め，泥状便が噴出していた．術後敗血症となり多臓器不全を合併した．

文献考察：癌部の穿孔の死亡率は9%，口側穿孔の死亡率は31%と高い．
Surgery. 2000 Apr;127(4):370-6.
Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.
Chen HS, Sheen-Chen SM.

BACKGROUND: In adenocarcinoma of the colon and rectum, obstruction and perforation may occur either alone or together at the site of the neoplasm or proximally. Both events carry a poor prognosis. This retrospective study sought to determine whether a correlation exists between perforation and obstruction, and between these conditions and different clinicopathological factors in colorectal adenocarcinoma. METHODS: The medical records of 1950 patients with colorectal adenocarcinoma treated in our hospital during a 7-year period were retrospectively analyzed. One hundred patients (5%) were excluded from this study because of a loss of follow-up. Data on clinicopathological factors including age, sex, tumor location, surgical mortality, pathological type, stage, and long-time cancer-free rate were simultaneously analyzed. Patients were grouped as follows: Group 1, complete colonic obstruction without perforation (n = 120). Group 2, complete obstruction with perforation at the site of the cancer (n = 35); Group 3, complete obstruction with perforation proximal to the cancer (n = 13); and Group 4, nonobstructing, nonperforated cancers (n = 1682). RESULTS: When compared with Group 4, Group 1 had a more advanced Dukes' stage, older age, greater incidence of colonic versus rectal cancers, and a poorer cancer-free survival (P independent factors favorable to cancer-free survival (> 5-year survival) were female gender (P = .035), well-differentiated pathology (P