UNUSUAL CAUSE OF ACUTE URINARY RETENTION (AUR) COLORECTAL ADENOCARCINOMA, METASTATIC TO URINARY BLADDER: CASE REPORT

Citation:
OLIECH JS, ODHIAMBO A, GACHIE A, BYAKIKA B. UNUSUAL CAUSE OF ACUTE URINARY RETENTION (AUR) COLORECTAL ADENOCARCINOMA, METASTATIC TO URINARY BLADDER: CASE REPORT.; 2013.

Abstract:

A 72 year old African male presented with a 2 weeks history of haematurla with clots, dysuria, nocturia, frequency and subsequently 2 day history of acute urinary retention (AUR). There were no colonic symptoms of mucus discharge, blood per rectum or malaena stools. Imaging studies demonstrated a tumour mass invading the roof of the urinary bladder whilst cyctoscopic finding were inconclusive. Following surgical intervention, the mass was subjected to histopathological evaluation which confirmed colonic adenocarcinoma matastasis in the urinary bladder. It is now 4 ½ years since surgery was carried out and follow up shows good prognosis.

Notes:

PATIENTS PROFILE: (Case report)
C.O.O. is a 72 year old male who presented with a 2 week history of haematuria with clots, dysuria, nocturia, urgency, frequency and subsequently a 2 day history of acute urinary retention (AUR). He admitted to history of moderate weight loss (8 month duration), fever on and off, weakness and moderate palor, No colonic symptoms especially no mucus discharge, blood per rectum or malaena stools except for abdominal pain related to urine problem.

He had suprapubic tenderness with a diffuse mobile mass difficult to delineate extending to right iliac fossa.

Digital rectal examination (DRE) revealed a moderately enlarged soft prostate gland with estimated volume of 40-50cc from transrectal ultrasonography, minimal post voidal urine volume of 15 cc (TRUS). No prostatic nodules. His prostatic specific antigen (PSA) was normal (<4.0 ng/ml) on three occasions.

Laboratory evaluation demonstrated anaemia of 8.4g/dl, dilutional hyponatraemia, Na+ 134 mmol/L, and creatinine of 128.8 mmols/L (upper limit 120). The rest of electrolytes were normal. Urine analysis and cytology were positive for proteins but negative for malignant cells. BARD test on urine was not done as the reagents for latex agglutination was not available.

Tumour markers such as carcinoembryonic antigen (CEA), Alpha feto-proteins (AFP) and CA 19-9 were all within normal range or negative.
Radiolographic evaluation included plain abdominal x-ray, abdominal and pelvic ultrasonography, contrast CT scans. The U/S showed a hypoechoic mass in the suprapubic/right iliac fossa measuring 6.4X4.2 cm (fig 1, 2). The origin remained unclear. It appeared separate from urinary bladder and prostate gland. Contrast CT scan of the abdomen/pelvis confirmed a hypo-gastric mass (fig 3). Multiplanar reformatted images showed deformation of the roof of the urinary bladder whose wall was thickened (fig 4,5). The prostate gland was moderately enlarged but exhibited uniform texture. There was no attendant ascites or para aortic lymphadenopathy (fig 5). Consideration included mesenteric tumour or abscess, Tuberculosis. Liver was normal (fig 6).

Anaemia and electrolytes derangement were corrected then a surgical intervention findings were that this was a bladder mass involving the sigmoid colon and terminal ileum, with no peritoneal “soiling” or seedling and no ascites. Partial urinary bladder cystectomy, segmental ileal resection and anterior colonic resection in mass was carried out in a 2 ½ hours operation and the entire mass “en bloc” was submitted as bladder mass to histopathologist for evaluation and analysis. Ileal end-to-end and colonic end-to-end anastomosis carried out. There were mesenteric lymph nodes sampling carried out. Indwelling urethral catheter left in situ for 4-5 days. Portevac drain for the pelvic cavity for 48 hours. Post operatively there were no events and patient was discharged on 10th post operative day.

Histopathological findings were that this was a well differentiated mucin secreting adenocarcinoma arising from the colonic cancer. There was transmural invasion with focal ulceration and extension into the ileum and urinary bladder wall. Excision margins were free of tumour. Final diagnosis made was Grade 1 adenocarcinoma of colon (Duke B) TNM T4, No Mo. Follow up for 4 ½ years with CT scans (fig 7 – 12) have not shown radiological or imaging evidence of recurrence and the patient has remained symptoms free. He has put on weight (over 8-10 kg) in the cause of 2 – 4 years, has good quality of life and active in his work place.The patient declined post operative chemotherapy or radiotherapy cover in the absence recurrence.

mps@africaonline.co.ke

PATIENTS PROFILE: (Case report)

C.O.O. is a 72 year old male who presented with a 2 week history of haematuria with clots, dysuria, nocturia, urgency, frequency and subsequently a 2 day history of acute urinary retention (AUR).  He admitted to history of moderate weight loss (8 month duration), fever on and off, weakness and moderate palor, No colonic symptoms especially no mucus discharge, blood per rectum or malaena stools except  for abdominal pain related to urine problem.

 He had suprapubic tenderness with a diffuse mobile mass difficult to delineate extending to right iliac fossa.

 Digital rectal examination (DRE) revealed a moderately enlarged soft prostate gland with estimated volume of 40-50cc from transrectal ultrasonography, minimal post voidal urine volume of 15 cc (TRUS).  No prostatic nodules. His prostatic specific antigen (PSA) was normal (<4.0 ng/ml) on three occasions.

 Laboratory evaluation demonstrated anaemia of 8.4g/dl, dilutional hyponatraemia, Na+ 134 mmol/L, and creatinine of 128.8 mmols/L (upper limit 120).  The rest of electrolytes were normal.  Urine analysis and cytology were positive for proteins but negative for malignant cells.  BARD test on urine was not done as the reagents for latex agglutination was not available.

 Tumour markers such as carcinoembryonic antigen (CEA), Alpha feto-proteins (AFP) and CA 19-9 were all within normal range or negative.

Radiolographic evaluation included plain abdominal x-ray, abdominal and pelvic ultrasonography, contrast CT scans.  The U/S showed a hypoechoic mass in the suprapubic/right iliac fossa measuring 6.4X4.2 cm (fig 1, 2).  The origin remained unclear.  It appeared separate from urinary bladder and prostate gland.  Contrast CT scan of the abdomen/pelvis confirmed a hypo-gastric mass (fig 3).  Multiplanar reformatted images showed deformation of the roof of the urinary bladder whose wall was thickened (fig 4,5).  The prostate gland was moderately enlarged but exhibited uniform texture.  There was no attendant ascites or para aortic lymphadenopathy (fig 5).  Consideration included mesenteric tumour or abscess, Tuberculosis.  Liver was normal (fig 6).

 Anaemia and electrolytes derangement were corrected then a surgical intervention findings were that this was a bladder mass involving the sigmoid colon and terminal ileum, with no peritoneal “soiling” or seedling and no ascites.  Partial urinary bladder cystectomy, segmental ileal resection and anterior colonic resection in mass was carried out in a 2 ½ hours operation and the entire mass “en bloc” was submitted as bladder mass to histopathologist for evaluation and analysis.  Ileal end-to-end and colonic end-to-end anastomosis carried out.  There were mesenteric lymph nodes sampling carried out.  Indwelling urethral catheter left in situ for 4-5 days.  Portevac drain for the pelvic cavity for 48 hours.  Post operatively there were no events and patient was discharged on 10th post operative day.

 Histopathological findings were that this was a well differentiated mucin secreting adenocarcinoma arising from the colonic cancer.  There was transmural invasion with focal ulceration and extension into the ileum and urinary bladder wall.  Excision margins were free of tumour.  Final diagnosis made was Grade 1 adenocarcinoma of colon (Duke B) TNM T4, No Mo.  Follow up for 4 ½ years with CT scans (fig 7 – 12) have not shown radiological or imaging evidence of recurrence and the patient has remained symptoms free.  He has put on weight (over 8-10 kg) in the cause of 2 – 4 years, has good quality of life and active in his work place.The patient declined post operative chemotherapy or radiotherapy cover in the absence recurrence.

 

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