Surgical Management in Complication of Adenocarcinoma & Large Incisional Hernia in an Aged Female

An aged female, 63 years old, was suffering With incomplete evacuation of stool and bleeding PR for a span of more than 6 months. Afraid of the COVID situation, she did not want to visit any doctor for medical management. She even tried home remedies to manage her condition, but all went in vain. Finally when her problems had enhanced to a great extent. she and her family members decided to visit a doctor for help. They visited us on 12th January 2021 at the out- patient department and we decided to perform a colonoscopy after initial physical examination. While performing the colonoscopy, we found a rectosigmoid mass from which tissue sample was collected and sent for biopsy. While going through her previous medical records, we found that she had a history of hypertension and diabetes mellitus. She also had a history of hysterectomy many years back with large swelling from right lumbar region (hernia from drain site). We planned a CECT (Contrast Enhanced Computed Tomography) of whole abdomen and thorax on the very next day. The CECT confirmed presence of a large mass at the rectosigmoid junction with lot of adhesion of the greater omentum to the sigmoid colon and previous hysterectomy site.

Unfortunately her biopsy report revealed adenocarcinoma in the rectosigmoid region (colon). Adenocarcinoma is a type of cancerous tumour which can occur in various parts of the body. It is seen that a vast majority Of colorectal cancers are adenocarcinomas. In almost all cases of colon cancer, it usually forms from a polyp which is initially a benign growth of the colon. Preoperative evaluation was performed and she was posted for surgery on 21st January 2021.

It was a very difficult dissection. Adhesiolysis (surgery for removing adhesions from the abdominal region) was done. After dissection, rectum and sigmoid colon were separated from the vaginal vault and urinary bladder. Both side ureter was identified and safe guarded. The sigmoid colon was resected with GIA (60mm) green. Upper rectum resected with TA (45mm) stapler. Hemostasis (stopping of flow of blood) was achieved. Colorectal anastomosis (it is the process by which joining together of the end of colon to the end of rectum) was also performed. The cancerous part was removed and post operatively patient was shifted to ITU. She received one unit of PRBC on the very same day. We performed a CECT of whole abdomen three days post surgery which revealed normal study and no anastomosis leakage was seen. On the ninth day post surgery. she had developed high grade fever. Urine test revealed growth of E. Coli which we had already suspected. She was treated with antibiotics according to culture sensitivity of her urine test. She was discharged on the 12th day post surgery when she had started tolerating oral diet.

We receive colon cancer patients quite often. But in this case, she had a large incisional hernia and major adhesion in the region of greater omentum to the sigmoid colon and the previous hysterectomy site. And also her condition had worsened due to late arrival at the hospital. Hence, please do not neglect any symptoms or complications, even if they are minor. The minor complications or symptoms become major when left untreated for a long period of time.