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.com
Volume 8
Surgery: Current Research Open Access
Surgery Asia Pacific 2018
August 17-18, 2018
August 17-18, 2018 Singapore
12
th
International Conference on
Surgery and Anesthesia
Tiffany Gould, Surgery Curr Res 2018, Volume 8
DOI: 10.4172/2161-1076-C3-041
Per-rectal bleeding in pregnancy is a case report of a 29-year-old female diagnosed with colonic
adenocarcinoma in the second trimester of pregnancy
Tiffany Gould
John Hunter Hospital, Australia
A
29-year-old female presented to a rural emergency department with per-rectal bleeding, describing up to 20 episodes
of painless hematochezia that day, on a background of bowels not opening for the preceding three days. She had some
associated abdominal pain but denied any blood clots, change in bowel habits, weight loss, nausea or vomiting. She was 15 weeks
pregnant at the time. There was no other past medical or surgical history and no regular medications. Her vital signs were within
normal limits, abdomen was soft non-tender and per-rectal examination revealed bright blood but no other abnormalities.
She had a proctoscopy done which showed internal haemorrhoids. The decision was made to further investigate the patient
with a flexible sigmoidoscopy, this revealed a suspicious lesion in the descending colon which was biopsied. Histological
analysis revealed a diagnosis of adenocarcinoma. The flexible sigmoidoscopy was followed by a formal colonoscopy confirming
the tumor at 25 cm from the anal verge, as well as two benign polyps. A staging non-contrast MRI scan pre-operatively
showed no evidence of any intra-thoracic, abdominal or pelvic metastases, there was no lymphadenopathy noted. There was
an area of concentric thickening of the sigmoid colon. The patient was also reviewed pre-operatively by the obstetrics and
gynecology team who commenced prophylactic oral progesterone, she was also referred to a specialist colorectal cancer center,
however she elected to be treated in her local hospital. The patient proceeded to undergo a planned resection at the local rural
hospital, the procedure was initially laparoscopic however was converted to an open approach because of difficulty visualizing
the operative field secondary to the fetus (with the uterus noted to be above the pelvic brim). The patient underwent a left
hemicolectomy with a primary anastomosis, the intra-operative leak test was negative. She was admitted to high dependency
units post operatively with fetal monitoring. Her post-operative recovery was unremarkable, and she was discharged to home
on day five. Histological results confirmed stage-IVB (pT4aN1cM1b) colonic adenocarcinoma.
Biography
Tiffany completed a Bachelor of Medicine from the University of Newcastle, awarded with distinction in 2015. She has completed further studies in Advanced
Surgical Anatomy, as well as a Diploma of Science and a Master of Traumatology awarded with distinction in 2017. Tiffany works as a clinical teaching fellow with
the University of Newcastle, a general surgical registrar in Hunter New England Health and has commenced a research higher degree in the field of Colorectal
Surgery and Preventative Medicine.
tgould201@gmail.comNotes: