# Apple Core Unveiled: Malignant Colonic Obstruction Revealing an Unknown Rectosigmoid Neoplasm With Foreign Body Impaction

**Authors:** Daniela Martins, Ricardo Vaz-Pereira, Cátia Ferreira, Pedro Costa, João Pinto-de-Sousa

PMC · DOI: 10.7759/cureus.51536 · 2024-01-02

## TL;DR

A 46-year-old man's chicken bone impaction revealed an unknown rectosigmoid tumor causing colonic obstruction, highlighting the link between foreign bodies and unexpected cancer detection.

## Contribution

This case report presents a rare instance where foreign body impaction led to the early detection of rectosigmoid neoplasm in a younger individual.

## Key findings

- An impacted chicken bone was found lodged in a previously unknown rectosigmoid tumor during surgery.
- Anatomopathological analysis confirmed mucinous adenocarcinoma with clear margins and one metastatic lymph node.
- The case emphasizes the importance of imaging and vigilance in diagnosing colorectal cancer in younger patients.

## Abstract

This case report highlights a rare clinical scenario of a 46-year-old male presenting with constipation and fecaloid vomiting due to an impacted chicken bone within an unidentified rectosigmoid neoplasm, leading to acute malignant colonic obstruction. Emergent exploratory laparotomy revealed an impacted chicken bone lodged in a previously unknown rectosigmoid tumor. An anatomopathological examination revealed a mucinous adenocarcinoma with clear margins and one pericolic metastatic lymph node. The postoperative period was uneventful, and the patient was proposed for adjuvant chemotherapy. The abrupt onset of symptoms allowed for an early diagnosis, emphasizing the unexpected association between foreign body impaction and incidental malignant obstruction. This case underscores the complexity of managing foreign body ingestion in the gastrointestinal tract and emphasizes the crucial role of diagnostic imaging in surgical planning. Furthermore, it draws attention to the potential occurrence of colorectal cancer in younger individuals, emphasizing the necessity for clinical vigilance and screening strategies beyond conventional age recommendations.

## Linked entities

- **Diseases:** mucinous adenocarcinoma (MONDO:0004957), colorectal cancer (MONDO:0005575)

## Full-text entities

- **Genes:** MLH1 (mutL homolog 1) [NCBI Gene 4292] {aka COCA2, FCC2, HNPCC, HNPCC2, LYNCH2, MLH-1}, MSH2 (mutS homolog 2) [NCBI Gene 4436] {aka COCA1, FCC1, HNPCC, HNPCC1, LCFS2, LYNCH1}, MSH6 (mutS homolog 6) [NCBI Gene 2956] {aka GTBP, GTMBP, HNPCC5, HSAP, LYNCH5, MMRCS3}, MAP2K7 (mitogen-activated protein kinase kinase 7) [NCBI Gene 5609] {aka JNKK2, MAPKK7, MEK, MEK 7, MKK7, PRKMK7}, PMS2 (PMS1 homolog 2, mismatch repair system component) [NCBI Gene 5395] {aka HNPCC4, LYNCH4, MLH4, MMRCS4, PMS-2, PMSL2}, ZHX2 (zinc fingers and homeoboxes 2) [NCBI Gene 22882] {aka AFR1, RAF}, MAPK1 (mitogen-activated protein kinase 1) [NCBI Gene 5594] {aka ERK, ERK-2, ERK2, ERT1, MAPK2, NS13}
- **Diseases:** death (MESH:D003643), Tumor Node Metastasis (MESH:D008207), perforation (MESH:D057112), asthenia (MESH:D001247), Malignant colorectal intestinal obstruction (MESH:D007415), hematochezia (MESH:D006471), tachycardia (MESH:D013610), ischemia (MESH:D007511), abdominal discomfort (MESH:D000007), bleeding (MESH:D006470), MAC (MESH:D002288), leukocytosis (MESH:D007964), GI obstruction (MESH:D005767), abdominal pain (MESH:D015746), CRC (MESH:D015179), weight loss (MESH:D015431), constipation (MESH:D003248), Rectosigmoid Neoplasm (MESH:D011350), neutrophilia (MESH:C563010), malignant colon obstruction (MESH:D003110), Sigmoid colon neoplasm (MESH:D012811), fecaloid vomiting (MESH:D014839), abscess (MESH:D000038), cancer (MESH:D009369), signet-ring cell carcinoma (MESH:D018279), lymphadenopathies (MESH:D008206), pain (MESH:D010146), bowel obstruction (MESH:D012778), adenocarcinoma (MESH:D000230), anorexia (MESH:D000855), liver metastases (MESH:D009362), fistula (MESH:D005402), tenderness (MESH:D063806), FBs (MESH:D005547), flatus (MESH:D005414), MSI (MESH:D053842), inflammatory (MESH:D007249)
- **Species:** Homo sapiens (human, species) [taxon 9606], Gallus gallus (bantam, species) [taxon 9031]

## Figures

5 figures with captions in the complete paper: https://tomesphere.com/paper/PMC10834070/full.md

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Source: https://tomesphere.com/paper/PMC10834070