Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Abstract

Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.

Atypical Small Bowel Obstruction Caused by Perforated Cecum: A Case Report

“…In lieu of commonly seen SBO etiologies, this case presented with an idiopathic perforated cecum causing an SBO. No large bowel obstruction was found during exploratory laparotomy, which is the leading cause of cecal perforation [5,6,18]. The patient's preoperative obstipation and lack of improvement after conservative management were indications for surgical intervention.…”

“…A cecal perforation that causes a small bowel obstruction is an extremely rare case. Most cases of cecum perforation have been associated with malignancies in the large bowel [5,6]. Cecal perforation normally tends to be a consequence of large bowel obstruction, due to a fully competent ileocecal valve that does not allow the retrograde flow of content [7].…”

Colonic perforation presenting as retroperitoneal abscess: case report and brief review of literature

“…Retroperitoneal abscesses may also result from microbial agents such as tuberculosis, Staphlococus aureus, E. coli, bacteroides species, or other rare bacteria, such as the actinomyces species. 4 Retroperitoneal abscess from colonic perforation is an unusual event with severe complication with overall mortality rate about 17%. The most common cause of colonic retroperitoneal perforation is diverticular disease.…”

“…2 Intestinal perforation may occur either through the tumor site or in a proximal location as a complication of mechanical obstruction caused by the tumor (diastatic perforation). 4 Retroperitoneal abscess is recognized as a life-threatening condition because of its insidious clinical manifestations and diagnostic difficulty via congenital anatomical communications, the retroperitoneal abscess has the potential to spread rapidly to the perinephric space, the psoas muscle, the lateral abdominal wall, and the lower extremities. The retroperitoneal infections are associated with a mortality rate approximately 20%.…”

Perforated caecal mass: benign or malignant?

“…Bowel perforation, a common but life‐threatening condition, often creates a surgical dilemma in terms of patient management and treatment. It could happen as a result of a benign or malignant pathology but generally occurs iatrogenically (after colonoscopy) or due to direct injury from trauma, perforation arising from tumour necrosis, ischaemic inflammatory bowel disease (diverticulitis, appendicitis, inflammatory bowel disease or colitis) or diastatic perforation caused by closed‐loop obstruction (volvulus or intestinal obstruction) 1–3 . Managing a caecal perforation as compared to other parts of the colon is challenging as the treatment needs to be both patient‐oriented and disease‐oriented.…”