Transanal endoscopic microsurgery – a case report

Transanal endoscopic microsurgery is currently a method of choice for adenomas located up to 20 cm from the anal verge, which cannot be removed using endoscopy. We present a case of a 67-year-old patient with rectal tumour, which was initially diagnosed as a neoplastic lesion with low-grade dysplasia and was treated using this method. We emphasise that this type of management is also advisable in the absence of the possibility of obtaining a histopathological result corresponding to the clinical features of the lesion. The tumour was located low in the distal rectum, reaching the sphincters on the posterior wall. The tumour had a diameter of 2 x 3.5 cm. Diagnostic imaging showed features suggestive of a neoplastic lesion. A complete resection of the tumour was performed using a surgical rectoscope. The wound was closed with a continuous, braided, absorbable suture. Hospital stay was 5 days. The resected specimen was diagnosed as G1 adenocarcinoma. A follow-up 4 weeks after the surgery showed a healed wound, with no signs of incontinence. Continence was assessed using the Wexner Continence Scale. After oncological consultation, the patient was qualified for adjuvant radiation therapy. Transanal endoscopic microsurgery (TEM) proved to be a safe and effective method in the presented case of rectal tumour with low-grade dysplasia.

Rectosigmoid carcinoma presenting as full-thickness rectal prolapse

A 34-year-old man with recent-onset constipation presented with colonic obstruction due to a palpable rectal tumour. Colostomy relieved the obstruction and biopsy revealed carcinoma. During workup, full-thickness rectal prolapse occurred with the tumour at the apex of an intussusception. Imaging revealed a low rectal tumour and no metastases. An abdominal oncological rather than perineal resection of the rectum was planned. At laparotomy, the tumour was reduced and was seen to originate at the rectosigmoid junction. Surgery was successful and follow-up has been clear. Histology revealed an adenocarcinoma with microsatellite instability. Rectal prolapse due to tumour intussusception is very rare. In this young man, it was due to straining at stool because of constipation and tenesmus rather than pelvic floor abnormality. An associated colorectal tumour should be considered in patients with rectal prolapse. In such cases, surgical and adjuvant management may need to be modified.