A rare case of three synchronous colorectal cancers and a closed loop large bowel obstruction

Abstract

Colorectal malignancies are a common general surgical presentation. However, synchronous colorectal cancers are less frequent and typically account for only 3.5% of all colorectal cancers. Of these 3.5% of synchronous colorectal cancers, only approximately 4% are incidental appendiceal malignancies. An 80-year-old gentleman presented with abdominal pain and distension to the emergency department. On examination, the patient had a peritonitic abdomen and a CT scan revealed a large bowel obstruction secondary to sigmoid and rectal neoplasms, concerning for a closed loop obstruction. He underwent an emergency laparotomy and Hartman's Procedure. Intraoperatively the tip of the appendix appeared dilated and was removed. Histology revealed T3N0M0 synchronous sigmoid and rectal cancers, as well as a low-grade appendiceal mucinous tumour. Whilst synchronous colorectal malignancies are a relatively common presentation they typically present in adjacent segments of bowel. They are less frequently seen in association with incidental appendiceal malignancies and no cases have been published in combination with a closed loop large bowel obstruction. This is the first published case of three synchronous colorectal cancers causing a closed loop large bowel obstruction.