Acute urinary retention in locally recurrent rectal cancer

Case contributed by Dr Nguyen, Hoang Nhat Khanh

Presentation

The patient had a radical rectectomy, the stoma was located in the left abdominal lower quadrant. Now he has acute urinary retention.

Patient Data

Age: 65 years
Gender: Male

The patient had a radical rectectomy, the stoma located in the left abdominal lower quadrant.

Multiple scattered hepatic nodules and masses throughout both lobes, poorly marginated, hypodensity, heterogeneous enhancement, measuring≤ 66 x 84 mm.

Nodular left adrenal thickening, measuring 17 x 13 mm.

Fat infiltration in the subcutaneous layer along the left abdominal wall to the stoma with skin thickening and visible gas bubbles scattered inside the lesion.

Distended bladder with urine and thin wall.

Diffuse right posterior pelvic wall thickening creates a mass lesion, poorly marginated, extending to the perineum, invading the perineal muscles, the prostate gland, the anus, the urethra, heterogeneous enhancement, measuring 50 x 45 x 100 mm (AP x trans x CC).

Case Discussion

This patient had a radical rectectomy, now he has a recurrent and metastatic lesion located in the right posterior pelvic wall, extending and invading the adjacent tissues, causing a lower urinary tract obstruction; that can explain the admission reason of this patient.

The left abdominal wall lesion is possibly due to inflammation. The presence of multiple focal hepatic nodules and masses are suggestive of metastases. Finally, the nodular left adrenal thickening is suggestive of metastases.

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