Acute abdomen in pregnancy revealing sigmoid colon carcinoma at caesarean section.
This case report describes metastatic sigmoid colorectal adenocarcinoma discovered during emergency caesarean section for acute abdomen at 32 weeks 6 days of pregnancy, followed by diversion colostomy, multidisciplinary care, and systemic chemotherapy with reported favourable maternal and neonatal outcomes.
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This case report describes metastatic sigmoid colorectal adenocarcinoma discovered during emergency caesarean section for acute abdomen at 32 weeks 6 days of pregnancy, followed by diversion colostomy, multidisciplinary care, and systemic chemotherapy with reported favourable maternal and neonatal outcomes.
Research significance
The record provides anecdotal evidence that prompt intraoperative recognition and multidisciplinary management can enable treatment of colorectal cancer presenting during pregnancy; it is only an inference—not established by comparative evidence—that this approach improves maternal or neonatal outcomes.
Source abstract
A primigravida at 32 weeks 6 days of gestation presented with abdominal pain and features of acute abdomen with suspected peritonitis of unclear aetiology. An emergency lower-segment caesarean section was performed resulting in delivery of a preterm neonate requiring neonatal intensive care. Intraoperatively, dense adhesions and a sealed perforation involving the sigmoid colon were identified, necessitating diversion colostomy and lymph node excision. Histopathology confirmed colorectal adenocarcinoma, and imaging revealed hepatic metastases. The patient was managed with a multidisciplinary approach and initiated on systemic chemotherapy with favourable maternal and neonatal outcomes. This case highlights the diagnostic challenges of acute abdomen during pregnancy and emphasises that both obstetric and non-obstetric causes, including rare conditions such as colorectal carcinoma, should be considered when the diagnosis remains uncertain. Careful intraoperative assessment may reveal unexpected pathology requiring multidisciplinary management.