P1276 - A Rare Presentation of Colon Cancer in a Young Female With Colonic Perforation

Gres Karim, MD¹, Erica Park, MD², Andrew Blank, MD^3
1Mount Sinai Beth Israel Medical Center, New York, NY; ²Mount Sinai West, Mount Sinai Morningside and Mount Sinai Beth Israel Hospitals, New York, NY; ³Mount Sinai Morningside and Mount Sinai West, New York, NY

Introduction: Early-onset colon cancer is diagnosed in less than 10% of patients under the age of 50, usually having a preference for the distal colon. Initial misdiagnosis of early-onset colorectal cancer occurs in up to 50% of cases. We present a young female who was initially thought to have a ruptured adnexal cyst but later found to have a perforated sigmoid colon secondary to adenocarcinoma.

Case Description/Methods: A 33-year-old female with no past medical history presented with intermittent lower abdominal pain worsening over the past month. She also reported intermittent rectal bleeding for the past year which she attributed to hemorrhoids. Initial examination revealed normoactive bowel sounds, abdominal tenderness to palpation in the left abdomen without rebound tenderness. Labs were remarkable for hemoglobin 6.6 and WBC 17. CT abdomen/pelvis with contrast was concerning for a ruptured left hemorrhagic ovarian cyst with moderate hemoperitoneum. She was transfused packed red blood cells and started on antibiotics. Despite measures, she remained tachycardic with rising WBC count. A repeat CT revealed a high-grade small bowel obstruction, increased hemoperitoneum, an organized 5.5 cm fluid collection in the pelvis, and multifocal irregularities in a short segment of the sigmoid colon. Emergent exploratory laparoscopy showed diffuse purulent peritonitis and a perforated sigmoid colon with an adjacent, walled-off abscess. She underwent laparoscopic sigmoid colectomy with end colostomy. Pathology of the sigmoid colon revealed invasive moderately differentiated adenocarcinoma with margins negative for tumor. CT chest suggested a 1 cm metastatic lesion in the lung. She subsequently completed FOLFOX therapy.

Discussion: This case demonstrates the rarity of young females presenting with colonic perforation secondary to colon cancer. Less than 10% of colon cancer cases present as fever, leukocytosis, and abdominal pain secondary to a localized contained perforation.The incidence of colorectal cancer rose 2.4% per year in patients ages 20-29 and 1.0% per year in those ages 30-39 from 1974 to 2013. These lesions are more likely found in the left colon. Many young patients initially present with rectal bleeding, frequently dismissed as hemorrhoidal bleeding. In this patient population, prompt recognition and thorough evaluation of rectal bleeding with modalities such as flexible sigmoidoscopy is crucial. These measures enhance prognosis, as a delay in surgical evaluation and intervention could worsen outcomes.


Disclosures:
Gres Karim indicated no relevant financial relationships.
Erica Park indicated no relevant financial relationships.
Andrew Blank indicated no relevant financial relationships.


Gres Karim, MD¹, Erica Park, MD², Andrew Blank, MD³. P1276 - A Rare Presentation of Colon Cancer in a Young Female With Colonic Perforation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.