Radiologically Suspected Locally Recurrent Rectal Cancer Presenting with Rectal Perforation and Rectocutaneous Fistula Years After Multimodal Therapy: A Case Report
Donia Zarzour, Philippe Attieh, Antonio Al Hazzouri, Tya Youssef, Rim Moubayed, Lamia Azizi, Karam KaramAbstract
Background
Local recurrence of rectal cancer after multimodal therapy may be difficult to distinguish from post-radiation changes and can lead to severe complications if diagnosis is delayed.
Case Presentation
We report the case of a 62-year-old woman with previously treated rectal adenocarcinoma who developed PET/CT findings suspicious for local recurrence despite benign colonoscopic biopsy showing post-radiation changes. Subsequent imaging demonstrated disease progression, and the patient presented with rectal perforation and a rectocutaneous fistula requiring urgent diverting colostomy, drainage, and antibiotic therapy. She improved clinically following multidisciplinary management.
Conclusion
This case highlights the diagnostic challenges of differentiating recurrent rectal cancer from post-radiation changes and underscores the importance of serial imaging and multidisciplinary evaluation when clinical suspicion persists despite negative biopsy findings.