The Successful Closure of Jejunostomy in Sigmoid Colon Cancer with Advanced Intra-Abdominal Carcinomatosis Rescued by Cytoreductive Surgery and Systemic Chemotherapy

Intra-abdominal carcinomatosis with intestinal obstruction is usually a terminal and refractory event. A 52-year-old woman underwent cytoreductive surgery and jejunostomy following a diagnosis of ileus obstruction due to recurrent sigmoid colon adenocarcinoma with advanced intra-abdominal carcinomatosis. She was further treated with biweekly chemotherapy with Oxaliplatin plus 5-FU (FOLFOX regimen). After 4 cycles of treatment of FOLFOX post-operatively, the patient started oral intake with tapered TPN. Despite good oral intake, the patient was dependent on large amount of intravenous fluid at home due to massive fluid loss from jejunostomy. After two more cycles of FOLFOX, and complete abdominal workup indicating good bowel movement, the patient had successful closure of the jejunostomy and became independent of intravenous fluid supplement. Our experience suggested aggressive multi-modality approach may be helpful in this difficult clinical situation. Meanwhile, early closure of enterostomy to assure quality of life in cancer patients is also feasible.