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1 . 2022

Difficulties in differential diagnosis and treatment tactics of presacral formations in a patient with rectal cancer progression (case report)

Abstract

Aim – to present a rare case of a benign presacral neurogenic tumor, preoperatively regarded as a local recurrence of colorectal cancer, in a patient with colorectal liver metastases, which had a cardiotoxic effect of chemotherapy.

Key points. A patient previously underwent anterior resection due to cancer of the upper rectum and received chemotherapy for the liver metastases diagnosed in the late postoperative period.

Due to specific hyperfixation of a contrast in the presacral area, near the colorectal anastomosis, and previously diagnosed liver metastases, the patient underwent an extrafascial low anterior resection, atypical liver resection of S4, S5/S8, S7. There were no complications in the postoperative period. Histological examination of the specimens demonstrated the presence of a benign neurogenic tumor in the presacral area, as well as metastases of adenocarcinoma in the resected liver tissue.

Conclusion. Resection of presacral tumors, regardless of their nature, usually leads to the development of neurological disorders. Safe and radical removal of such tumors, as well as the complexity of the following postoperative management, requires a multidisciplinary team, including surgeons of various specializations (coloproctology, neurosurgery, urology) and neurologists, rehabilitation therapists to ensure optimal course of the intraoperative and postoperative period, reducing the duration of inpatient treatment, and ensuring the timely resumption of chemotherapy.

Keywords:colorectal cancer; metastatic colorectal cancer; schwannoma; presacral tumor; case report

Funding. The work was carried out within the framework of research work 0394-2021-0011.
Conflict of interest. The authors declare no conflict of interest.
For citation: Bedzhanyan A.L., Petrenko K.N., Bredikhin M.I., Sumbaev A.A., Konstantinova Yu.S., Tyurina E.A., Dymova O.V., Frolova Yu.V. Difficulties in differential diagnosis and treatment tactics of presacral formations in a patient with rectal cancer progression (case report). Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 128–34. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-128-134  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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