Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2017; 5(1): 18-23
Published online Jan 16, 2017. doi: 10.12998/wjcc.v5.i1.18
Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy: A case report and literature review
Nobuhisa Takase, Kimihiro Yamashita, Yasuo Sumi, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Yoshiko Matsuda, Takeru Matsuda, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yu-Ichiro Koma, Masato Komatsu, Ryohei Sasaki, Yoshihiro Kakeji
Nobuhisa Takase, Kimihiro Yamashita, Yasuo Sumi, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Yoshiko Matsuda, Takeru Matsuda, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji, Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Yu-Ichiro Koma, Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe 657-8501, Japan
Masato Komatsu, Division of Diagnostic Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe 657-8501, Japan
Masato Komatsu, Department of Surgery, Hyogo Cancer Center, Akashi 673-8558, Japan
Ryohei Sasaki, Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe 657-8501, Japan
Author contributions: Yamashita K and Sumi Y operated on the patient and designed the report; Hasegawa H, Yamamoto M, Kanaji S, Matsuda Y, Matsuda T, Oshikiri T, Nakamura T and Suzuki S drafted the paper; Koma YI, Komatsu M, Sasaki R and Kakeji Y critically revised the paper with an important conceptual and editorial input.
Institutional review board statement: This case report was exempt from the Institutional review board standards at Kobe University Graduate School of Medicine and Hospital, Kobe, Japan.
Informed consent statement: The patient participant to the study provided informed written consent.
Conflict-of-interest statement: The authors declare no conflict of interest associated with this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kimihiro Yamashita, MD, PhD, Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. kiyama@med.kobe-u.ac.jp
Telephone: +81-78-3825925 Fax: +81-78-3825939
Received: August 24, 2016
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
Abstract

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.

Keywords: Local advanced rectal cancer, Preoperative chemoradiotherapy, Rectal perforation, 5-fluorouracil, Tumor necrosis

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.