Rectosigmoid carcinoma presenting as full-thickness rectal prolapse

Abstract

A 34-year-old man with recent-onset constipation presented with colonic obstruction due to a palpable rectal tumour. Colostomy relieved the obstruction and biopsy revealed carcinoma. During workup, full-thickness rectal prolapse occurred with the tumour at the apex of an intussusception. Imaging revealed a low rectal tumour and no metastases. An abdominal oncological rather than perineal resection of the rectum was planned. At laparotomy, the tumour was reduced and was seen to originate at the rectosigmoid junction. Surgery was successful and follow-up has been clear. Histology revealed an adenocarcinoma with microsatellite instability. Rectal prolapse due to tumour intussusception is very rare. In this young man, it was due to straining at stool because of constipation and tenesmus rather than pelvic floor abnormality. An associated colorectal tumour should be considered in patients with rectal prolapse. In such cases, surgical and adjuvant management may need to be modified.

Rectal prolapse as the initial presentation of rectal cancer—A case report

“…The authors advocated routine screening for cancer using endoscopy, though no plausible explanation of the increased risk was offered (21). Most of the subsequent authors seconded their proposal for endoscopic surveillance based solely on sporadic case reports (7)(8)(9)(10)(11)(15)(16)(17)(18). Speculation is that chronic straining, mechanical irritation of mucosa, and obstipation might increase the colorectal cancer risk in patients with chronic rectal prolapse.…”

“…Namely, there are only a handful of published cases of rectal prolapse-containing cancer, with the first dating back to 2004 (8). It is possible that the condition was underreported because, in the last decade, there has been an increasing number of reports on this particular issue (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). We have researched published literature through PubMed using the keywords "rectal prolapse" and "rectal adenocarcinoma or cancer," which yielded 75 articles.…”

“…We have researched published literature through PubMed using the keywords "rectal prolapse" and "rectal adenocarcinoma or cancer," which yielded 75 articles. A detailed study of the articles and their references found only nine relevant cases of rectal cancer with rectal prolapse (8,10,(12)(13)(14)(15)(16)(17)19), where two more reported prolapses of sigmoid cancer (9,18).…”

“…Underlying bowel tumorous growth is a rare cause of prolapse but can occur even in children (4)(5)(6). A rising number of authors in the last decade published rectal or sigmoid adenocarcinoma cases leading to the presentation as a rectal prolapse (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Anorectal emergencies: WSES-AAST guidelines

“…After assessing patient's hemodynamic status, a contrast enhanced abdomino-pelvic CT scan should be performed to investigate potential conditions associated with complicated RP [213][214][215][216], such as acute bowel obstruction, signs of perforation and peritonitis, prolapse of other pelvic organs (uterus, vagina and/or bladder, sigmoid colon, small bowel) [217], and to rule out the presence of colorectal malignancy. A sudden RP could be the first clinical manifestation of a colon cancer, as demonstrated by several case reports [218][219][220][221]; therefore, multiple authors suggest that patients with rectal prolapse should have endoscopic examination of the colon and rectum. Akyuz et al hypothesized that the age group in which RP is most commonly seen, the change in bowel habits, the chronic constipation, and mucosal irritation related to this disease, could be the factors that increase the incidence of rectum cancer in patients with RP and concluded that endoscopic screening should not be overlooked in this specific population [222].…”