Ascending colon malignancy presenting as large bowel obstruction: a rare case report

Abstract

Colorectal cancer is the third most common cancer in both men and women and the fourth most common cause of cancer related deaths. It can be classified as sporadic (70%), inherited (5%) and familial (25%), various genetic pathways are involved. Carcinomas of right colon are known to be relatively silent lesion producing non-specific symptoms like fatigue, weakness, and vague lower abdominal pain. Whereas, left colon carcinomas are frequently more dramatic presenting as altered bowel habits, bloody mucoid stools, and obstruction. Most importantly almost 50% of left sided cancers present as a palpable growth of lower rectum. Emergency right hemicolectomy is the treatment of choice for an obstructing right colon malignancy, options varies from open/lap right hemicolectomy with a primary ileo-transverse anastomosis in a stable patient with or without diverting ileostomy or placement of endoluminal self-expanding metallic stent (SEMS). Here we present a case 47 year old female who presented with abdominal pain and vomiting for 2 days and was diagnosed with mid ascending colon growth with distended caecum and proceeded with emergency laporotomy. Intraoperatively circumferential constrictive growth seen in ascending colon with impending perforation in caecum and was subjected to a right hemicolectomy with end-to-end ileo-transverse anastomosis with an uneventful post-operative period.