Malignant perforation of sigmoid colon in long-standing ulcerative colitis

Abstract

Chronic ulcerative colitis (UC) is a risk factor for malignancy in long-term disease process. Obstruction, perforation, and hemorrhage are the possible emergency situations in colorectal malignancy. A 68-year-old male with chronic UC for 18 years with steroid-dependent disease (on 10 mg prednisolone daily) presented with acute pain abdomen with distention not passing stool or flatus for 2 days. The patient was diagnosed to have perforation of colon secondary to rectosigmoid malignancy. Following the adjuvant therapy, the patient denied any definitive surgery and opted to stay on a colorectal cancer surveillance program. At present, the patient's positron emission tomography/computed tomography shows pelvic, liver surface, and small bowel deposits, suggestive of recurrence or metastasis. This case report is discussed to emphasize the importance of aggressive surgical treatment in long-term steroid-dependent disease and poor prognosis of perforated malignancy irrespective of pathological staging.

Keywords

• chronic ulcerative colitis
• perforated colonic malignancy
• steroid-dependent ulcerative colitis