A case report of managing large bowel obstruction from colorectal cancer in the presence of multiorgan hydatid disease: a multidisciplinary challenge

Abstract

Large bowel obstruction may represent a surgical emergency due to the risk of sepsis and hemodynamic instability, particularly given the underlying etiologies such as colorectal malignancies. Hydatid cyst mainly occurs in the liver and may migrate to other organs, particularly the lungs. It may remain asymptomatic for years, often discovered incidentally during abdominal ultrasound. Coexistence of colorectal cancer and hydatid cyst is a rare phenomenon, which when presenting, demands close cooperation of surgical, oncological and infectious diseases specialties to ensure proper management. This is the case of a 48-year-old female known to have pulmonary and hepatic hydatid cyst who presented for symptoms of large bowel obstruction and leukocytosis. Abdominal CT scan revealed severe colonic dilation of the sigmoid colon and cecum, consistent with obstruction. Rectosigmoidoscopy showed a polylobed polyp at the rectosigmoid junction which was pathologically identified as noninvasive tubulovillous adenoma with carcinoma in situ. Colonoscopy also revealed a large ulcerating stenotic tumor causing obstruction, which was relieved by laparoscopic left lateral colostomy. A colonoscopy via colostomy confirmed the absence of further polyps or tumors. A second surgery was done for laparoscopic oncologic sigmoid resection with colorectal anastomosis to ensure colon mobilization and adequate integrity and perfusion of the colostomy, along with left adnexectomy to prevent tumor extension or metastasis. Pathology confirmed the resected tumor to be a moderately differentiated adenocarcinoma invading up to the serosa. This staged surgical approach allowed the relief of obstruction via colostomy via the colostomy thus avoiding the higher anastomic leak risk of immediate resection in a severely dilated colon. Tumor staging was performed revealing stage IIb. Following infectious disease and oncology consultation, the patient was started on concomitant albendazole and chemotherapy for hydatid cyst and colorectal cancer respectively. This case emphasizes the importance of multidisciplinary collaboration in such dual pathology to ensure appropriate management and avoid unintended multi-therapeutic interactions.