ONCOLOGICAL EMERGENCIES RELATED TO COLORECTAL CANCER AND THEIR POSSIBLE INTERVENTIONS: CASE REPORT

Abstract

Case presentation: A 50-year-old man was admitted to Santa Casa de Misericórdia de Presidente Prudente with colicky abdominal pain and distension for five days, progressing to cessation of flatus and feces, in addition to significant worsening of pain for two days. He denied comorbidities, surgical history, or previous alterations in bowel movement. Clinical decompression measures were initiated for management of the occlusive acute abdomen, and a computed tomography (CT) scan of the abdomen and pelvis revealed an expansile mass in the sigmoid colon, measuring 80 x 61 x 66 mm, determining bowel obstruction. He underwent exploratory laparotomy and found an obstructive lesion in the transition from the descending to the sigmoid colon, adherent to the retroperitoneum and right ureter, but with a cleavage plane. A rectosigmoidectomy with primary anastomosis, retroperitoneal lymphadenectomy, and omentectomy were performed. The patient's postoperative progress was satisfactory, with a diet on day 2 and discharged on day 7. Discussion: Colorectal cancer (CRC) ranks third in global incidence, with approximately 1.9 million new cases and 0.88 million deaths annually. Around 90% of cases are identified in advanced stages or as emergencies. Sigmoid colon cancer is asymptomatic initially and is diagnosed late, causing abdominal pain, changes in bowel habits, obstruction, or bleeding. Therefore, screening is important, as it reduces its incidence and mortality. In emergency situations such as bowel obstruction or perforation, computed tomography (CT) is the examination of choice because it provides crucial details for diagnostic confirmation, which is essential for treatment selection. Treatment in these emergency situations may include colectomy with primary anastomosis or end ileostomy, the latter associated with a risk of fluid and electrolyte disturbances. Thus, in oncological emergencies, different surgical techniques aim to reverse the imminently life-threatening condition. CRC, often diagnosed in advanced stages, can manifest as intestinal obstruction, one of the main surgical emergencies associated with the disease. In the reported case, CT revealed a large obstructive tumor in the sigmoid colon, adherent to the ureter and abdominal wall, findings confirmed intraoperatively. The patient underwent rectosigmoidectomy, retroperitoneal lymphadenectomy, and omentectomy, demonstrating the importance of a comprehensive surgical approach, even in an emergency setting, focusing on resolving the obstruction and oncological control, which are fundamental for staging and treatment planning. Final comments: This case reinforces the importance of early screening, such as colonoscopy, which can detect precursor lesions and reduce complications. It is also important to emphasize that personalized surgical management is crucial for resolving the condition and optimizing the prognosis.