# Bowel Obstruction as the Initial Presentation of Urothelial Carcinoma

## TL;DR

A rare case of bladder cancer causing bowel obstruction is reported, highlighting the importance of considering unusual diagnoses in abdominal tumors.

## Contribution

This paper presents a unique clinical case linking urothelial carcinoma with bowel obstruction as an initial symptom.

## Key findings

- An 80-year-old patient had bowel obstruction caused by bladder-originating urothelial carcinoma.
- The tumor invaded the ileum and sigmoid colon, necessitating en-bloc resection.
- Histopathology confirmed high-grade undifferentiated urothelial carcinoma invading the gastrointestinal tract.

## Abstract

Bowel obstructions are one of the main causes of hospital admissions for acute abdominal pain. In addition, bladder cancer is one of the most common cancers in the world. This said, bowel obstruction and bladder cancer are very frequent diseases but the same cannot be said about the association between these two pathologies.

We report a unique case of an 80-year-old patient admitted to the emergency room with a bowel obstruction caused by a urothelial carcinoma with adrenal metastasis.

The patient underwent an urgent laparotomy, and intraoperative inspection of the peritoneal cavity confirmed a large tumorous mass suspected of gastrointestinal etiology. The mass infiltrated the ileum and sigmoid colon and was apparently in contact with the bladder wall. An en-bloc resection of the lesion was performed. An R0 excison was not possible and fragments of the lesion were excised from the bladder wall for separate analysis.

Histopathological examination of the resected specimen described a high-grade, undifferentiated urothelial carcinoma that originated in the bladder and invaded the ileum and sigmoid colon.

The presence of an invasive urothelial carcinoma presenting with bowel obstruction represents an unexpected diagnosis and, although rare, the surgeon must be aware of this possibility. This case should serve as a reminder that a broad differential diagnosis should be considered when investigating an abdominal tumor.