Rectal prolapse associated with intussusception and malignancy

Rectal prolapse as an initial presentation of colorectal cancer: a systematic review

BACKGROUND

Colorectal cancer rising incidence still pose a public health challenge. In the present systematic review, we aimed to study the colorectal cancer patients with initial presentation of rectal prolapse.

METHOD

The study protocol was developed (PROSPERO CRD42017060473). We searched Web of Science, PubMed and Scopus to identify case reports of rectal Prolapse as a chief compliant of colorectal cancer. The Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) guidelines were used for screening and data extraction.

RESULTS

Thirty-one case reports were included in this review. More than half of the patients were females over 65 years old and mean ± SD age of the cases were 64 ± 17.9 years and, the female gender were mentioned in 17 (56%) case reports. The majority (64.5%) of the identified cancer belong to rectum and recto-sigmoid origin's location. In the history retained from the cases, rectal bleeding and constipation were the most frequent reported accompanied symptoms in colorectal cancer cases with initial presentation of rectal prolapse. 67.7% of all identified cases in this review published at 2015 and later.

CONCLUSION

Rectal prolapse can be an initial presentation of colorectal cancer, which is more prevalent in female more than 65 years old. The most common symptoms accompanied rectal prolapse were rectal bleeding and constipation. According to rising published case reports on colorectal cancer patients with initial presentation of rectal prolapse in recent years, further work-up is recommended for patients without predisposing factors for a concomitant tumor.

A case report of a giant ileocecal cystic prolapse through the anus and literature review

Intussusception refers to the invagination of a proximal loop of the bowel into an adjacent distal segment. This condition is rare in adults, especially when it involves a complete folding of the ileocecal area out of the body cavity. Meanwhile, enterogenous cysts are congenital malformations that are largely identified in childhood following symptoms of bowel obstruction. While surgical treatment is ultimately required for both diseases, deciding on the type of surgery and the right time to operate can be a challenge for clinicians. It is especially difficult to decide on treatment for an adult with the coincidental occurrence of both conditions and no definitive pathologic diagnosis prior to surgery. Here, we present the case study of a 19-year-old female patient who presented with a prolapsed anus due to intussusception caused by a large ileocecal mass. The patient was admitted to the emergency department with a "massive anal mass." She remained symptomatic after receiving conventional conservative treatment and had to undergo emergency surgery after developing an intestinal obstruction. While the patient's intraoperative condition also confirmed the preoperative CT findings, the situation became more complicated during surgery. The postoperative pathological report indicated the presence of an enterogenous cyst. After recovery from surgery, the patient was successfully discharged. Intussusception or intestinal obstruction caused by an intestinal mass is a surgical indication, and removal is the only way to cure the condition. This case study provides a helpful reference for general surgeons, especially anorectal surgeons, imaging physicians, and pathologists, and informs the diagnosis and treatment of this patient population.

A rare case of sigmoid intussusception. A case report

INTRODUCTION AND IMPORTANCE

Colorectal intussusception can be quite challenging to identify, especially its malignant nature. This is a fairly rare presentation and hence, there is not much associated research or cases reported in the literature.

CASE PRESENTATION

We present a 69 year old male with lower abdominal pain and a significant rectal prolapse. He has a background history of heavy smoking and significant alcohol intake. The prolapse was irreducible and had papillomatous changes present on the prolapsed mucosa. A computerized tomography (CT) scan demonstrated a large rectal prolapse followed by a Magnetic Resonance Imaging (MRI) Pelvis which showed an intussusception at the S2-3 level, consistent with a carcinoma, The patient then proceeded to have a flexible sigmoidoscopy with a planned proceed to an anterior resection. Histopathology revealed sigmoid and descending colon adenocarcinoma with mucinous differentiation pT3N0. He had an unremarkable hospital stay and remained well on follow up. His case was discussed at the multidisciplinary meeting and was not for any adjuvant chemotherapy.

CLINICAL DISCUSSION

Imaging can help aid early diagnosis of a colorectal intussusception. Colonoscopies can be useful too; however these can be tricky to diagnose pre-operatively. If there is a high suspicion of malignancy, routine resection is the preferred method of treatment in cases of colorectal intussusception.

CONCLUSION

Although not a very common presentation, diagnosis of colorectal cancer presenting as an intussusception can be dealt with imminently by considering operative measures.