Published online Jan 16, 2017. doi: 10.12998/wjcc.v5.i1.18
Peer-review started: August 25, 2016
First decision: October 28, 2016
Revised: November 11, 2016
Accepted: December 1, 2016
Article in press: December 2, 2016
Published online: January 16, 2017
Processing time: 137 Days and 14.3 Hours
Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.
Core tip: Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induces rectal perforation. This case report presents a case of rectal perforation in a patient with LARC in the midst of 5-fluorouracil-based preoperative CRT. We decided to complete CRT according to the original plan after supporting emergency recovery. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis, suggesting the efficacy of the CRT. We believe that establishing a standard treatment for CRT-related LARC perforation may improve the prognosis of such cases.