What happened, in summary

A man in his 50s came to hospital with abdominal pain, nausea, vomiting, and constipation caused by a small-bowel obstruction. Colonoscopy found a tumor at the ileocaecal valve, and biopsy showed moderately differentiated adenocarcinoma. He underwent open right hemicolectomy with removal of an involved segment of small bowel. Pathology showed pT4aN1b disease with clear margins. He then completed 12 cycles of adjuvant FOLFOX.

Two years into surveillance, colonoscopy found cancer returning at the surgical connection between the bowel segments. PET-CT did not show widespread disease, so he underwent another open operation to remove the recurrent area and create a new ileocolic connection.

He later developed a firm mass in the abdominal wall at the site of a previous surgical drain. Imaging and biopsy confirmed another isolated recurrence. Surgeons removed the skin, fat, muscle, and peritoneum around the mass in one piece to obtain clear margins. The abdominal wall was then rebuilt with mesh.

His recovery was uncomplicated. He had returned to his usual baseline by the first postoperative day, left hospital on day 5, and was reviewed again after 2 weeks. Follow-up continued every 3-6 months. At the latest assessment, there was no clinical evidence of another recurrence or distant metastasis, and no abdominal-wall weakness or hernia had developed.

Each recurrence remained isolated enough for another operation rather than treatment for widespread metastatic disease. The drain-site recurrence also made examination of old incision and drain areas important during surveillance. Clear margins were achieved at the abdominal-wall operation.