Colorectal Malignancies Presenting as a Surgical Emergency

Abstract

Background: Gastrointestinal malignancies are common tumours. Emergency presentation of these cases represents a diagnostic and therapeutic challenge and carries a higher rate of mortality and morbidity compared to instances of colorectal tumours operated upon electively. Most of these patients had previous symptoms suggestive of colorectal pathology.

Objectives: To identify factors in the clinical history of the patient with colorectal malignancy presenting as an acute surgical emergency that may help in early detection of these cases.

Methods: a retrospective study of 47 patients histopathologically proven to have colorectal carcinoma and presented as abdominal emergencies at AL-Yarmouk teaching hospital from January 2022 to December 2022. Data obtained include age, gender, history, presentation, type of surgery, morbidity and mortality.

Results: Emergency presentation of colorectal carcinoma represents 38.84% of the total cases registered during the period of the study. Thirty-nine patients were above 50 years old (82.96%). Most of the patients have associated comorbidities (82.97%). Most of the patients had a history of symptoms related to the GIT (82.35%), especially constipation (40.43%) and frequent usage of enema (34.04%), with only 8.51% having had a previous colonoscopy. The majority of the patients presented with intestinal obstruction (70.21%). All patients underwent emergency surgery, which consisted of definitive resection (38.30%), staged resection (46.80%), and palliative resection (14.90%). Tumours were found to be advanced in 63.83% of the cases.

Conclusions: One-third of the colorectal malignancies presented as abdominal emergencies. With associated comorbidities and previous clinical history suggesting colorectal disease. A good screening program will decrease the incidence of this problem.