Faria Aldara, Jordão Daniel, Figueira Alberto, Pereira Teresa, Ferreira Carlos
Department of General Surgery, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Departamento de Cirurgia Geral, Unidade de Saúde Local de Santa Maria, Avenida Professor Egas Moniz MB, 1649-028 Lisbon, Portugal; Faculty of Medicine of the University of Lisbon, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz MB, 1649-028 Lisboa, Portugal.
Department of General Surgery, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Departamento de Cirurgia Geral, Unidade de Saúde Local de Santa Maria, Avenida Professor Egas Moniz MB, 1649-028 Lisbon, Portugal; Faculty of Medicine of the University of Lisbon, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz MB, 1649-028 Lisboa, Portugal.
Int J Surg Case Rep. 2024 Dec;125:110613. doi: 10.1016/j.ijscr.2024.110613. Epub 2024 Nov 15.
Acute lower gastrointestinal bleeding is one of the most common causes of hospital admission. However, massive bleeding is uncommon and is mainly due to hemorrhoidal bleeding in elderly patients receiving anticoagulant therapy. We present a rare case of a massive rectal haemorrhage with an uncommon cause.
A 60-year-old woman was admitted to the emergency department with a two-day history of lower gastrointestinal bleeding. During digital rectal examination and anoscopy, a palpable mass located 8 cm from the anal verge with severe bleeding was detected. Subsequent rectosigmoidoscopy revealed a bulge in the rectal wall with mucosal ulceration and signs of recent bleeding. The CT-scan revealed a 74 × 41 mm locally advanced rectal mass and three hepatic lesions (segments 6 and 7). Pathology results were compatible with synovial sarcoma (SyS). The case was discussed by a sarcoma board, and the patient underwent doxorubicin plus ifosfamide resulting in a significant reduction of the metastatic lesions and complete remission of the primary lesion on MRI. Following multidisciplinary discussion, low anterior resection of the rectum with terminal colostomy and right posterior sectionectomy were performed. At 23 months follow-up, the patient shows no signs of recurrence.
SyS are uncommon malignant tumours, accounting for 5-10 % of all soft tissue sarcomas. Metastatic SyS carries a poor prognosis.
Gastrointestinal involvement is exceptionally rare and, to the best of our knowledge, this is the third rectal SyS case reported in the literature. Because of this, SyS should be managed in sarcoma referral centers.
急性下消化道出血是住院治疗的最常见原因之一。然而，大出血并不常见，主要发生在接受抗凝治疗的老年患者的痔疮出血。我们报告一例罕见的因罕见原因导致的大量直肠出血病例。
一名60岁女性因下消化道出血两天入住急诊科。在直肠指检和肛门镜检查中，发现距肛缘8厘米处有一个可触及的肿块，伴有严重出血。随后的直肠乙状结肠镜检查显示直肠壁有一个隆起，伴有黏膜溃疡和近期出血迹象。CT扫描显示一个74×41毫米的局部晚期直肠肿块和三个肝脏病变（第6和第7段）。病理结果与滑膜肉瘤（SyS）相符。该病例由肉瘤专家委员会进行讨论，患者接受了多柔比星加异环磷酰胺治疗，导致MRI上转移病灶显著减少，原发灶完全缓解。经过多学科讨论后，进行了直肠低位前切除术加末端结肠造口术和右后段切除术。在23个月的随访中，患者没有复发迹象。
滑膜肉瘤是罕见的恶性肿瘤，占所有软组织肉瘤的5%-10%。转移性滑膜肉瘤预后较差。
胃肠道受累极为罕见，据我们所知，这是文献报道的第三例直肠滑膜肉瘤病例。因此，滑膜肉瘤应在肉瘤转诊中心进行治疗。
