The patient is a women in her 60s. After medical examinations, she was told that the result of fecal occult blood reaction testing was positive. Moreover, colonoscopy found type 2 cancer in her sigmoid colon. The patient underwent sigmoidectomy. The 3D dissection of lymph node and colorectal side-to-end anastomosis were performed. Pathologically, the case was diagnosed as moderately differentiated adenocarcinoma (stage II). Adjuvant chemotherapy was not given. During follow-up observation, the tumor marker levels were elevated above normal. A work-up revealed a recurrence of the cancer on the abdominal wall. The lesion was surgically removed with a margin of about 2 cm from the tumor secured. Pathological diagnosis of this recurrent case was not inconsistent with the previous diagnosis of sigmoid colon cancer. As the relapse was thought to be due to the implantation of cancer cells in the abdominal wall, we need to follow the surgical procedure with scrupulous care and exercise the utmost precaution to protect incision wound on the abdominal wall.

BACKGROUND/AIMS: Propofol sedation for elderly patients during time-consuming endoscopic procedures is controversial. Therefore, we investigated the safety of using propofol in elderly patients during upper gastrointestinal therapeutic endoscopy. METHODS: The medical records of 160 patients who underwent therapeutic endoscopic procedures under gastroenterologist-guided propofol sedation at a single institution were retrospectively reviewed. The subjects were divided into two groups: a younger group, patients <75 years old; and an elderly group, patients > or =75 years old. The two groups were compared with respect to the therapeutic regimen, circulatory dynamics, and presence/absence of discontinuation of propofol treatment. RESULTS: Although the number of patients with liver dysfunction was higher in the elderly group, there were no other significant differences in the baseline characteristics, including the American Society of Anesthesiologists classification, between the elderly and younger groups. The average maintenance rate of continuous propofol infusion was lower in the elderly patients. No statistically significant differences were found in the occurrence of adverse events between the elderly and younger groups. None of the patients returned to a resedated state after the initial recovery from sedation. CONCLUSIONS: Gastroenterologist-guided propofol sedation in elderly patients can be safely achieved in the same manner as that in younger patients, even for time-consuming upper gastrointestinal therapeutic endoscopic procedures.
Age Factors ; Aged ; Aged, 80 and over ; Conscious Sedation/adverse effects/*methods ; *Endoscopy, Gastrointestinal/methods ; Female ; Humans ; *Hypnotics and Sedatives/adverse effects ; Male ; *Propofol/adverse effects ; Retrospective Studies