Bridging Colostomy Enabling Laparoscopic Left Colectomy for Obstructed Splenic Flexure Cancer in Early Pregnancy: Case Report and Literature Review

Abstract

Obstructed colorectal carcinoma during pregnancy is rare, and optimal management remains poorly defined. Laparoscopic resection following decompression has seldom been reported, particularly during early pregnancy. A 34-year-old woman at 14 weeks’ gestation presented with one week of constipation and progressive abdominal distension. Non-contrast magnetic resonance imaging demonstrated an obstructing splenic flexure tumor with proximal colonic dilatation. A loop transverse colostomy was created to decompress the colon and allow a staged management approach. Diagnostic colonoscopy performed via the anus and stoma confirmed adenocarcinoma, with a preoperative carcinoembryonic antigen level of 4.1 μg/L. At 17 weeks’ gestation, the patient underwent elective laparoscopic left hemicolectomy with primary anastomosis. The specimen was resected en bloc through the stoma site to minimize additional abdominal incisions. Histopathologic examination revealed moderately differentiated adenocarcinoma, pT4aN0 (0/48 lymph nodes), with negative margins and no lymphovascular or perineural invasion. Postoperative recovery was uneventful, and fetal viability was confirmed before discharge on postoperative day five. At 34 weeks’ gestation, emergency Cesarean delivery was performed following failed induction of labor. The infant was delivered alive with good Apgar scores. The patient subsequently started adjuvant chemotherapy six weeks postpartum. A bridging colostomy allows safe decompression and facilitates planned laparoscopic oncologic resection during the early second trimester while preserving pregnancy. This staged approach during pregnancy has been reported in eight cases, utilizing either colostomy or colonic stenting. Colostomy may be preferred over stenting in early pregnancy due to concerns regarding radiation exposure.