Amin Hiral, Salas-Parra Ruben D, Stantley Lauren, Rajee Nirmala K, Gowda Vinayak S
Department of Surgery, Bronxcare Health System, Bronx, NY, USA.
American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten.
J Surg Case Rep. 2021 Jan 18;2021(1):rjaa565. doi: 10.1093/jscr/rjaa565. eCollection 2021 Jan.
This is an unusual case of an obstructive rectal squamous cell carcinoma (SCC), causing perforation and a pelvic abscess, requiring source control and diverting colostomy. A 50-year-old female with chronic constipation presented with worsening right buttock pain for 1 month. On exam, the patient reported right hip tenderness. A computer tomography (CT) revealed rectal wall thickening with a presacral abscess. Due to the concern of rectal perforation with abscess she was taken to the operating room for proctoscopy with biopsy, colostomy diversion and drainage of the abscess over the right buttock. Pathology reported invasive rectal SCC. Rectal SCC presents similarly to rectal adenocarcinoma but its diagnosis must include special markers for cytokeratins. The treatment approach is controversial but adequately treated offers better survival than rectal ADC. Rectal SCC is rare and treated with chemoradiation however it must also be tailored to the variable acute presentations.
这是一例罕见的梗阻性直肠鳞状细胞癌（SCC）病例，导致穿孔和盆腔脓肿，需要进行源头控制和结肠造口转流术。一名患有慢性便秘的50岁女性出现右臀部疼痛加重1个月。检查时，患者报告右髋压痛。计算机断层扫描（CT）显示直肠壁增厚并伴有骶前脓肿。由于担心直肠穿孔合并脓肿，她被送往手术室进行直肠镜检查及活检、结肠造口转流术以及右臀部脓肿引流。病理报告为浸润性直肠SCC。直肠SCC的表现与直肠腺癌相似，但其诊断必须包括细胞角蛋白的特殊标志物。治疗方法存在争议，但得到充分治疗的患者比直肠腺癌（ADC）患者的生存率更高。直肠SCC很罕见，采用放化疗进行治疗，不过治疗方案也必须根据不同的急性表现进行调整。
