Secondary peritonitis to abdominal sepsis in a patient with colostomy for colon cancer: a critical surgical case report.

Abstract

Colostomy is a common surgical procedure in the management of advanced or complicated colorectal cancer. Although generally well tolerated, it may be associated with severe complications such as local tumor progression, stoma infection, intestinal obstruction, and bowel perforation, potentially leading to abdominal sepsis and peritonitis. Timely diagnosis and prompt surgical
intervention are essential to reduce morbidity and mortality. This article aims to present the case of a patient with stage IIIA rectal adenocarcinoma and colostomy who developed a severe septic complication due to local tumor progression requiring emergency surgical management. Case report. A 55-year-old male with a history of rectal adenocarcinoma and colostomy presented with abdominal pain, fecaloid vomiting, purulent peristomal discharge, and hypotension. Due to renal dysfunction, contrast-enhanced CT imaging was contraindicated; therefore, magnetic resonance imaging (MRI) was performed, revealing a complex pelvic inflammatory mass, free intraperitoneal fluid, and tumor infiltration of the stoma. Emergency exploratory laparotomy revealed generalized peritonitis, necrosis of the rectal stump, invaginated stoma, and gangrenous omentum. Surgical management included left colectomy, peritoneal lavage, resection of the compromised stoma, and creation of a new transverse colostomy. Results. The patient was admitted to the intensive care unit in critical condition, requiring vasopressor support, broad-spectrum antibiotics, and aggressive fluid resuscitation. A progressive postoperative recovery was observed, with improvement in inflammatory markers, renal function, and hemodynamic stability, allowing ICU discharge on postoperative day seven. Conclusion. Septic complications secondary to malignant colostomy progression are rarebut potentially fatal if not addressed promptly. When contrast-based imaging is contraindicated, alternative modalities such as MRI play a critical role. Early exploratory laparotomy for diagnostic and therapeutic purposes, alongside multidisciplinary care, is essential for favorable outcomes in critically ill oncologic patients.