Carcinoma Rectum Case | Dr. Harshal Rajekar
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Case Summary
- Case Title: Carcinoma Rectum
- Final Diagnosis: Adenocarcinoma Rectum, Grade 3, Node Negative (T2N0M0)
Patient Profile
- Age/Sex: 74-year-old female
Past Surgical History:
- Right knee replacement – previously done
- Left hip replacement – performed 2 months ago
Clinical Course
- Following her hip replacement, the patient developed deep vein thrombosis (DVT) and pulmonary embolism, for which she was admitted and started on anticoagulant therapy.
- Subsequently, she developed per rectal bleeding and anemia.
- On evaluation, a rectal growth was identified approximately 1–2 cm from the dentate line.
Diagnosis
- Histopathology: Adenocarcinoma rectum, Grade 3
- Staging: T2N0M0 (Node negative)
Surgical Procedure
- Operation Performed: Ultra-Low Anterior Resection (LAR) of the rectum with radical left sigmoid colectomy, transanal endorectal pull-through, and coloanal anastomosis
- Patient Position: Reverse Trendelenburg with mild lithotomy
Key Steps:
- Ultra-low resection with total mesorectal excision (TME)
- Sphincter preservation achieved, as the patient was unwilling for abdominoperineal resection (APR) and permanent colostomy
Intraoperative Findings
- Blood loss: Minimal
- Procedure: Successfully completed without complications
Postoperative Course
- Recovery: Uneventful
- Outcome: Stable postoperative condition with preserved continence and no major morbidity
Take-Home Message
- Unforeseen problems often call for innovative surgical solutions.
- In carefully selected patients, ultra-low anterior resection with sphincter preservation offers an excellent functional and oncologic outcome, even in low rectal cancers.
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