Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy: A case report and literature review

Figure 1 Evaluation of clinical findings. Colonoscopy showed a circumferential mass at the lower rectum (A); Sagittal magnetic resonance imaging (MRI) of the pelvis showed rectal mass with involvement prostate and seminal vesicles (red arrows) (B), and perirectal fat (C); The enlarged lymph node in the left obturator detected by coronal MRI (red arrow) showed obvious metabolically active foci 18-fluorodeoxyglucose-positron emission tomography/computed tomography evaluation (D).

Figure 2 Rectal tumor perforation suggestive of chemoradiationdamage. Radiotherapy was delivered to the whole pelvis through three (one posterior-anterior and two lateral) or four (one anterior-posterior, one posterior-anterior and two lateral) fields using a 10-MV linear accelerator in the prone position (A); Coronal computed tomography findings showed a small bubble of extra-luminal gas (red arrow) (B); Preoperative colonoscopicfindings for radical surgery showed excavation with mucosa necrosis (red arrow) suggestive of chemoradiationdamage in the rectal tumor (C).

Figure 3 Histological findings of the resected specimen showed a wide field of tumor necrosis with fibril formation (H-E stain).