Obstructive Colitis Due to Rectal Cancer Diagnosed in a Middle-aged Patient Who Presented with Cardiopulmonary Arrest：A Case Report

Abstract

A 58-year-old man, who visited our hospital for hematochezia and abdominal distension was found unresponsive in the restroom. He was transferred to the emergency room and diagnosed as being in cardiopulmonary arrest. The initial cardiac rhythm was asystole; however, return of spontaneous circulation was achieved with cardiopulmonary resuscitation and advanced cardiovascular life support. Laboratory results revealed elevated levels of inflammatory markers, coagulopathy, acute kidney injury, hypoxia, and mixed acidosis, and computed tomography showed a rectal tumor measuring 6 cm in diameter. We diagnosed the patient as being in septic shock caused by obstructive colitis associated with advanced rectal cancer. He was initiated on intensive care, including mechanical ventilation, fluid resuscitation, catecholamine support, and antibiotic treatment. Subsequently, insertion of a transanal ileus tube was attempted under colonoscopic guidance for bowel irrigation and decompression, and a large amount of muddy feces was drained. However, despite these treatments, the patient remained in a state of shock and developed acute respiratory distress syndrome and disseminated intravascular coagulation; he died of multiple organ failure 10 hours after admission. Later, Klebsiella oxytoca was cultured from the blood sample, and histopathological examination of a rectal mucosal biopsy specimen revealed well-differentiated tubular adenocarcinoma.