Advanced Rectosigmoide adenosquamous carcinoma complicated by perforation and sepsis: a case report
Autores
Filipe Amorim Cruz*, Carolina Coutinho*, Vitor Neves Lopes, Elisabete Barbosa, Silvestre Carneiro * First authors.
Resumo Introdução
Adenosquamous carcinoma of the colorectum is a rare, aggressive tumor, often diagnosed at advanced stages and frequently presenting with complications such as perforation, resulting in poor prognosis.
Resumo Métodos
Aim: To describe a rare case of perforated rectosigmoid adenosquamous carcinoma with complex postoperative evolution.
Resumo Resultados
A 55-year-old woman with no prior medical history presented with an acute abdomen, following a 6-month history of weight loss, anorexia, night sweats, and progressive lower abdominal pain. In the Emergency Department, she was febrile, tachycardic, hypotensive, and showed signs of peritonitis and sepsis. CT revealed pneumoperitoneum, distal sigmoid thickening suspicious for neoplasia, and multiple hepatic lesions. She underwent emergent anterior rectal resection with terminal colostomy and liver biopsy. Postoperatively, she developed paralytic ileus and rectal stump dehiscence, requiring reoperation. Persistent intra-abdominal collections required percutaneous drainage and prolonged antibiotics, while ongoing stump dehiscence was then managed with endoscopic vacuum therapy. Pathology confirmed pT4a N2a adenosquamous carcinoma with liver metastases. Multidisciplinary discussion recommended palliative chemotherapy.
Resumo Discussão
This case illustrates the aggressive behavior of rectosigmoid adenosquamous carcinoma and its propensity for severe complications. Urgent surgical intervention and coordinated multidisciplinary care are essential in managing this rare malignancy.