A Case of Rectal Cancer with Hemorrhagic Shock with Bleeding Controlled via Stent Placement That Underwent Radical Resection after Preoperative CRT

• Published in: Gan to kagaku ryoho Vol. 49; no. 13; p. 1488
• Main Authors: Ami, Katsunori, Suyama, Yuto, Nakanishi, Akihito, Hakozaki, Tomoki, Harada, Toshiko, Monma, Satoko, Tamura, Noriyasu, Ooide, Kei, Machinami, Rikuo, Umetani, Naoaki
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-12-2022
• Subjects: Aged; Anemia; Chemoradiotherapy; Hemorrhage; Humans; Male; Melena; Rectal Neoplasms - complications; Rectal Neoplasms - surgery; Shock, Hemorrhagic; Stents
• ISSN: 0385-0684

Colorectal stents are used mainly for the palliative treatment of colorectal obstruction or preoperative re-obstruction. However, the hemostatic effect of covered stents reportedly induced bleeding of esophageal cancer and varicosities. Here, we report a case of mildly obstructed rectal cancer with severe anemia and hemorrhagic shock that resulted in pulsatile tumor bleeding. Curative surgical resection was performed successfully after the administration of chemoradiotherapy. The patient was a 67-year-old man. A nearby doctor diagnosed him with anemia(Hb 4.6 g/dL)and referred him to our hospital, where he was diagnosed with rectal cancer at the Ra position. He was immediately hospitalized owing to voluminous melena, loss of consciousness, and hematoma formation on the posterior aspect of the head. Urgent CF was performed due to persistent melena and decreased blood pressure. The pulsatile bleeding from rectal cancer was identified. To address the diffuse bleeding, a covered stent was placed to induce hemostasis and dilation. This also served as a bridge to surgery( BTS). Hemostasis was successfully achieved. After chemoradiotherapy( CRT), a laparoscopic low anterior resection was performed. Radical surgery was performed, and S-1 was taken 6 months postoperatively. At 2 years postoperatively, metastatic recurrence was not observed.