Intestinal obstruction due to rectal neoplasia in a patient with ulcerative colitis undergoing surgery with total mesorectal excision: case report and literature review
- 1School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
Abstract
Introduction and importance:: Ulcerative colitis (UC) is a chronic inflammatory disease associated with an increased colorectal cancer risk 8–10 years after diagnosis. Total proctocolectomy is usually elective and indicated for high-grade dysplasia or adenocarcinoma detected during surveillance colonoscopy. This report describes an unusual urgent case involving total mesorectal excision in a UC patient with intestinal obstruction due to a rectal lesion suspected of malignancy.
Case presentation:: A 38-year-old woman with UC presented with acute intestinal obstruction due to a rectal stenosis suggestive of neoplasia. She underwent total proctocolectomy with total mesorectal excision and terminal ileostomy. Histopathology revealed moderately differentiated rectal adenocarcinoma. The patient recovered well and initiated adjuvant chemotherapy, which was changed owing to radiological evidence of peritoneal implants detected 1 year after surgery. She has no further evidence of peritoneal involvement, as seen on a PET/CT scan performed 2.5 years after surgery.
Clinical discussion:: Patients with UC of more than 7 years’ duration have up to a tenfold higher risk of malignancy, underscoring the need for annual colonoscopy from the eighth year onward, particularly in pancolitis. Total proctocolectomy is indicated when dysplasia or carcinoma is detected. Performing oncologic surgery with total mesorectal excision and high vascular ligation in an emergency setting is uncommon.
Conclusion:: This case illustrates a rare malignant rectal transformation in long-standing UC, presenting with acute intestinal obstruction. Oncologic total proctocolectomy was feasible as an urgent procedure, given the patient’s condition and the colorectal surgery team’s availability in the emergency unit. The case emphasizes the importance of continuous surveillance and individualized surgical decision-making in emergency settings.
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BibTeX
@article{valente2026intestinal,
title = {{Intestinal obstruction due to rectal neoplasia in a patient with ulcerative colitis undergoing surgery with total mesorectal excision: case report and literature review}},
author = {Maria Stella Vasconcelos Sales Valente and Mayara Marina Sousa Senzano and Lívia Moreira Genaro and Luisa Souza Echeverria and Maria de Lourdes Setsuko Ayrizono and Raquel Franco Leal},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = sep,
doi = {10.1097/rc9.0000000000001088},
url = {https://doi.org/10.1097/rc9.0000000000001088},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Intestinal obstruction due to rectal neoplasia in a patient with ulcerative colitis undergoing surgery with total mesorectal excision: case report and literature review
AU - Maria Stella Vasconcelos Sales Valente
AU - Mayara Marina Sousa Senzano
AU - Lívia Moreira Genaro
AU - Luisa Souza Echeverria
AU - Maria de Lourdes Setsuko Ayrizono
AU - Raquel Franco Leal
PY - 2026
DA - 2026/09/29
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001088
UR - https://doi.org/10.1097/rc9.0000000000001088
AB - Introduction and importance:: Ulcerative colitis (UC) is a chronic inflammatory disease associated with an increased colorectal cancer risk 8–10 years after diagnosis. Total proctocolectomy is usually elective and indicated for high-grade dysplasia or adenocarcinoma detected during surveillance colonoscopy. This report describes an unusual urgent case involving total mesorectal excision in a UC patient with intestinal obstruction due to a rectal lesion suspected of malignancy. Case presentation:: A 38-year-old woman with UC presented with acute intestinal obstruction due to a rectal stenosis suggestive of neoplasia. She underwent total proctocolectomy with total mesorectal excision and terminal ileostomy. Histopathology revealed moderately differentiated rectal adenocarcinoma. The patient recovered well and initiated adjuvant chemotherapy, which was changed owing to radiological evidence of peritoneal implants detected 1 year after surgery. She has no further evidence of peritoneal involvement, as seen on a PET/CT scan performed 2.5 years after surgery. Clinical discussion:: Patients with UC of more than 7 years’ duration have up to a tenfold higher risk of malignancy, underscoring the need for annual colonoscopy from the eighth year onward, particularly in pancolitis. Total proctocolectomy is indicated when dysplasia or carcinoma is detected. Performing oncologic surgery with total mesorectal excision and high vascular ligation in an emergency setting is uncommon. Conclusion:: This case illustrates a rare malignant rectal transformation in long-standing UC, presenting with acute intestinal obstruction. Oncologic total proctocolectomy was feasible as an urgent procedure, given the patient’s condition and the colorectal surgery team’s availability in the emergency unit. The case emphasizes the importance of continuous surveillance and individualized surgical decision-making in emergency settings.
SN - 2210-2612
ER -