Malignancies of the Lower Gastrointestinal Tract Presenting as Acute Abdomen

Abstract

ABSTRACT
Background: Many cases of lower gastrointestinal malignancy present for the first time
as acute abdominal emergencies. These may be caused by acute intestinal obstruction or
perforation of the tumor. These cases are associated with higher morbidity and mortality
compared to cases of colorectal tumors operated upon electively. Many of these patients
had previous clinical history suggestive of colorectal pathology.
Objectives: To evaluate the previous clinical history and the current clinical presentation
and investigations, so that acute abdominal emergencies caused by colorectal tumors can
be predicted and detected earlier.
Methods: The study was conducted in Al-Yarmouk Teaching hospital from September
2011 to September 2012. It is a prospective study of all cases of colorectal malignancies
presenting for the first time as acute abdomen and treated surgically. Past and present
clinical data, results of investigation, surgical findings and procedures were documented in
detail.
Results: There were 65 patients with emergency presentation of colorectal malignancy
during the period of the study, 63.1% males and 36.9% females. They represented 40% of
all cases of colorectal tumors and 53.8% of the patients were above 60 years of age. In
89.2% of the patients there were comorbid conditions. Seventy-seven percent had past
history of colorectal-related symptoms mainly alteration in bowel habits (29.2%) and
9.25% had previous colonoscopy. In 67.7% there was intestinal obstruction and in 32.2%
perforation. Emergency surgery was done for all patients and was definitive in 36.2% of
patients and temporary colostomy in 63.8%.
Conclusions: More than one third of patients with colorectal malignancy may present
primarily as acute abdominal emergencies, either due to obstruction or perforation. The
majority of those patients will have previous clinical history suggesting colorectal disease
or tumor. A good screening program will decrease the incidence of this problem.