Synchronous Multiple Primary Malignant Adenocarcinoma of the Descending Colon and Fungating Bleeding Adenocarcinoma of the Terminal Ileum Presenting Massive Rectal Bleeding: A Trap for the Unwary

Abstract

Primary cancer of the ileum is rare, and when it occurs in conjunction with primary colon cancer, it becomes even more infrequent and challenging to diagnose prior to surgical intervention. Primary small bowel cancers can be overlooked and may be misidentified as small bowel mesenchymal tumours or advanced metastases from colon cancer. We present an exceedingly uncommon case of ruptured primary ileal cancer combined with primary descending colon cancer presenting with gastrointestinal bleeding. Based on our understanding, instances of dual tumours concurrently occurring are exceedingly infrequent. In this patient, there was a preoperative suspicion of bleeding from colon cancer in the descending region. However, intraoperative exploration revealed that the location of the bleeding was a terminal ileal mass. Following the surgical intervention, the patient recovered satisfactorily. Intraoperative exploration of the entire gastrointestinal tract is therefore necessary in patients with gastrointestinal haemorrhage, especially in those who require urgent surgery without adequate preoperative investigations. If a mass is detected at the end of the ileum, intraoperative pathology should be performed if feasible. Subsequently, if the diagnosis reveals an adenocarcinoma, terminal ileocolic resection and right hemicolectomy are necessary for appropriate resection.

Keywords:

• multiple primary malignant neoplasms
• gut bleeding
• adenocarcinoma of the small bowel
• descending colon cancer
• gastrointestinal tumours
• case report

Abbreviations

MPMNs, multiple primary malignant neoplasms; MSI-H, microsatellite instability-high; dMMR, mismatch repair gene-deficient; NCCN, National Comprehensive Cancer Network.

Data Sharing Statement

The paper includes all data related to the study.

Ethics Approval and Consent to Participate

Ethical approval for this study was obtained from the Ethics Committee of the Institutional Review Board of the Second Affiliated Hospital of Dalian Medical University. Written informed consent for this case report was obtained from the patient, who consented to the publication of the relevant details and imaging data in her case.

Disclosure

The authors report no conflicts of interest related to this work.

Additional information

Funding

There is no funding to report.