Mechanical malignant bowel obstruction in the settings of general department: clinical case

Abstract

Introduction. Bowel obstruction is the most common complication of advanced colorectal cancer. Patients are often hospitalized with suspected intestinal obstruction of unknown origin, until after many studies the diagnosis of malignant bowel obstruction is confirmed. This is because early colorectal cancer in most cases is asymptomatic, so patients see a doctor only in the later stages. Case presentation. A 63 year-old patient was admitted urgently at the Department of General Surgery, Municipal Hospital nr.1 presenting with diffuse abdominal pain, nausea, vomiting and constipation. History of disease: mild abdominal pain he already felt 6 months ago. He was referred to ultrasonography, which showed only prostate hyperplasia, followed by appropriate conservative therapy. As the pain was progressing a diagnosis of gastritis was made and he followed the treatment for it, nevertheless without any effect, as the pain became worse. He also noted that he had lost 10 kg in the last 6 months. On admission total leukocyte count was 11,1*10^9/l and hemoglobin – 95g/l. Abdominal radiography showed dilated bowel loops with air-fluid levels. The patient underwent emergency surgery. Intraoperatively, a tumor (8x6x6 cm size) with invasion in the retroperitoneal space and multiple metastases in the omentum and in the lower pole of the right kidney was detected. Because the tumor was considered as inoperable, a palliative surgery was performed: side-to-side ileotransversostomy. Biopsy of the specimen revealed adenocarcinoma, moderately differentiated (intermediate grade), T4N1M1, G2. On the 14th day after admission, the patient developed fever 38,5. The ultrasound scan revealed an abdominal fluid collection. A decision of relaparotomy was made with drainage of abdominal abscesses and protective loop ileostomy. The patient recovered and was discharged 35 days later. Discussion. If colorectal cancer were detected in the early stages, patients' life expectancy would be much higher. In this case the success of treatment was due to a correct and prompt therapeutic management. Conclusion. Despite the current availability of effective diagnostic methods, colorectal cancer continues to be detected at an advanced stage. There appears to be a need for a screening program for people with a history of hereditary colorectal cancer and for patients with documented digestive disorders.