Intestinal obstruction due to rectal neoplasia in a patient with ulcerative colitis undergoing surgery with total mesorectal excision: case report and literature review
Year: 2026
Type: article
Study design: Case Report
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.
Institution: Universidade Estadual de Campinas (UNICAMP)
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7225701215