Case Presentation
A 72-year-old woman was referred for further evaluation of left lower quadrant abdominal pain, blood per rectum and dark stools. Colonoscopy had been attempted but could not be completed due to sigmoid tortuosity. There was suggestion of a sigmoid mass, but this could not be confirmed endoscopically and biopsies of the area in question revealed necrotic tissue and atypical cells indeterminate for malignancy. The patient’s most recent colonoscopy was 7years prior.
She had a complicated medical history mostly related to her multiple congenital anomalies. Her bladder exstrophy was addressed by ureterosigmoidostomy diversion in the neonatal period that was subsequently revised to ileal conduit at age 21. She had undergone numerous prior abdominal and pelvic operations. Her other comorbidities included right sided aortic arch, coronary artery disease, atrial fibrillation, congestive heart failure, chronic kidney disease and chronic vaginal prolapse. The patient had no personal or family history of colon cancer or inflammatory bowel disease.
The initial step in our evaluation was another attempt to establish a diagnosis with colonoscopy, which confirmed the presence of a partially obstructing mass in the distal sigmoid [Fig 1]. Biopsies revealed adenocarcinoma. Staging revealed no evidence of distant metastatic disease. At operation, the tumor was found to be invading the retroperitoneum, and remnant distal ureter stumps were found in the region of the tumor, still anastomosed to the sigmoid [Fig 2]. Anterior resection of the rectosigmoid with en bloc resection of the retroperitoneum and the remaining ureters attached to the colon, and construction of colorectal anastomosis was performed. Histologic evaluation revealed pT3-4N0 adenocarcinoma with negative margins and 0/30 nodes involved with tumor. The patient had an uncomplicated recovery.