RECURRENT RECTAL CANCER COMPLICATED WITHPERFORATION AND NECROTISING FASCIITIS DURINGNEOADJUVANT THERAPY

摘要

INTRODUCTION: RECTAL CANCER LOCAL RECURRENCE IS LESS FREQUENT SINCE MULTIDISCIPLINARYAPPROACH HAS BEEN IMPLEMENTED, USUALLY TME EXCISION BEING PERFORMED AFTER NEOADJUVANTTHERAPY. IN CASE OF RECURRENCE, NEOADJUVANT THERAPY, INCLUDING STANDARD DOSE RADIOTHERAPYSHOULD BE CONSIDERED IF NOT PERFORMED INITIALLY. PATIENTS PREVIOUSLY IRRADIATED, CAN BENEFITOF LOWER-DOSES RE-IRRADIATION CONCOMITANT WITH CHEMOTHERAPY, FACILITATING A CURATIVESURGICAL RESECTION.CASE REPORT: IT IS PRESENTED THE CASE OF A 68 YEARS OLD PATIENT, WHO PERFORMED A RECTAL ANTERIORRESECTION WITH COLO-RECTAL ANASTOMOSIS FOR RECTAL TUMOR 4 YEARS BEFORE IN ANOTHER MEDICALUNIT. THE PATIENT IS DIAGNOSED WITH RECURRENCE INVOLVING THE ANASTOMOSIS, FOR WHICHMULTIDISCIPLINARY TEAM RECOMMENDED RADIOCHEMOTHERAPY PRIOR TO SURGERY. DURING THENEOADJUVANT THERAPY, BEFORE THE LAST CHEMOTHERAPY CURES THE PATIENT IS EMERGENCY SUBMITTEDTO SURGERY SERVICE FOR INFLAMMATORY TUMEFACTION WITH NECROTISING FASIITIS IN THE RIGHTISCHIORECTAL FOSSA. A FIRST SURGERY CONSISTING IN DRAINAGE AND EXTENSIVE DEBRIDEMENT ALSOOBESERVES RECTAL WALL PERFORATION. A SECOND IMMEDIATE INTERVETION CONSISTING IN A TERMINALCOLOSTOMY IS PERFORMED. AFTER ANTIBIOTHERAPY, LOCAL DRESSINGS, AND SEPTIC CONTROL OF THEWOUND AN ABDOMINO-PERINEAL SALVAGE RESECTION IS DONE, AN IMPORTANT SKIN DEFECT REMAINING.CONCLUSION: A QUICK AND EFICCIENT MANAGEMENT OF A SEVERE CONDITION PERMITTED NOT ONLY TOCONTROL A LIFE THREATENING SITUATION , BUT ALSO PERFORMING AN ABDOMINO-PERINEAL RESECTION. AMORE OFTEN OR MAYBE ROUTINELY USE OF DIVERTING COLOSTOMY BEFORE RADIOCHEMOTHERAPY SHOULDBE CONSIDERED IN CASE OF RECURRENT RECTAL CANCER, DETAILED STUDIES BEING NECESSARY ON THISASPECT.