Case 2-2018: A 40-Year-Old Woman With Gastrointestinal Hemorrhage and Final Pathologic Diagnosis of Rectal Adenocarcinoma

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Shahrzad Shokri Mehrdad Taghipour


Colon adenocarcinoma is the most frequent type of colorectal cancer histopathologically (1). Low physical activity levels, Obesity, low intake of fruit and vegetables, and overconsumption of red meat can predispose individuals to develop this malignancy (2). Change in bowel habits, Occult bleeding, Abdominal pain, Back pain, malaise and pelvic pain are the most clinical manifestations (3). Here in this case presentation study we report a middle aged person with rectal hemorrhage.

A 40-year-old woman was referred to Imam khomeini hospital Sari-Iran with chief complaint of rectal bleeding for about 6-7 months period. The symptoms had become worse during past two months. There was no history of abdominal pain, vomiting , nausea, chronic constipation, significant fever or weight loss. No underlying disease was reported. The patient's medical history was also negative. Neither she was allergetic to any drug or food , nor she was addicted. Her family history also did not include any special or significant disease. At the time she arrived at hospital, she was completely consious and could respond to the questions well. On initial physical examination, the vital signs revealed a normal range. In her abdominal examination no tenderness and rebound tenderness was detected. But a 1cm mass was touched in TR examination.

The patient's laberatory findings showed no anemia, with normal blood coagulation tests and liver function tests results. Moreover other biochemical test were aslo normal.

In order to diagnose the problem a colonoscopy was conducted in which the diagnosis was a tumoral mass in Rectum that was adjucent to Anus. No other  gross lesion was seen up to Cecum (Figure 1). In order to determine the stage of this tumor an Endoscopic ultrasound (EUS) was performed. In the sonography's report a T1N0 low rectum malignancy was indicated (Figure 2). A biopsy was taken too. The pathology report was  suggestive for adenocarcinoma in the patient's rectum. To find out any metastasis in the abdominopelvic cavity a spiral CT scan was conducted in which only a thickness in rectal wall was seen.

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