Introduction: Incidence of colorectal carcinoma been rising dramatically. Variability in the sign-symptom of colorectal carcinoma poses significant challenge to the physician. Early detection through widely applied screening program is most important in early diagnosis. Objectives of the study was to determine the site of lesion and various presentation, correlate clinical and laparotomy findings and immediate surgical complications of colorectal carcinoma.

Methods: The study included 25 adult patients with clinical and histo-pathological evidence of colorectal carcinoma. Demographic data as well as parameters relating to the symptoms, sites, diagnosis, preoperative findings and postoperative complications were retrieved.

Results: The maximum cases were in 31-40 years age group, male: female ratio was 2.1:1. Rectum was most common site of involvement (13; 52%cases). Rectal carcinoma presented with per rectal bleeding (10; 40%cases), sense of incomplete evacuation (9; 36%cases) and altered bowel habit (8; 32%cases). Right sided lesion presented with weakness and weight loss (5; 20%cases) and with unexplained pallor (4; 16%cases). Clinically mobile growth was found in 18cases (72%), but curative resection was done in 15(60%) cases. Postoperatively 3cases (12%) developed wound infection and 1case (4%) developed fecal fistula.

Conclusion: Often the early symptoms are so light that the patient does not seek advice for six month or more. For this in our country patients present with colorectal carcinoma at advanced stage. So we have to focus on sign-symptoms for early detection and apply best curable surgical facility improve quality of life.F

• Colorectal Carcinoma

Parveen F, Shoeb-Ur-Rashid M, Afrin T, Salam F, Nahar S, et al. (2026) Clinical Diagnosis and Surgical Management of Colorectal Carci noma- A Study of 25 cases. JSM Gastroenterol Hepatol 13(1): 1140.

Colorectal cancer, commonly known as colon cancer or large bowel cancer is a cancer from uncontrolled cell growth in the colon or rectum. Colorectal cancer is one of the commonest malignant lesions both men and women in all racial and ethnic group aged 50 or more [1]. It is more common in developed than developing countries [2]. Symptoms of colorectal cancer may present as long as several years before the diagnosis is made [3]. Constitutional symptoms (fatigue, shortness of breath, angina) secondary to anemia may be the principle presentation of the right colon. Bright red blood passes per rectum or coating the surface of stool is common with cancer of the left colon and rectum. Rectal cancer also causes obstruction and changes in the bowel habit. Symptomatic patients with colorectal cancer are often misdiagnosed [1].

Despite clinical advancement in diagnosis, patients in our country having colorectal carcinoma got admitted in relatively an advanced stage. It is due to their ignorance, illiteracy and poor socioeconomic condition, etc. They usually suffer from the consequence rather than the symptoms and die from the complications. When colorectal carcinoma is diagnosed at an early stage it can be curable. 5 year survival is 90%, when diagnosed at an early stage [4]. So, an early diagnosis is important.

Surgery remains the primary treatment while chemo and/or radiotherapy may be recommended. The goal of surgery is wide resection of the involved segment of bowel together with removal of its lymphatic drainage vessels [4]. The aim of this study is to observe various presentation of colorectal carcinoma and immediate outcome of their surgical management.

The study was carried out at the, Department of Surgery in Shaheed Suhrawardy Medical College hospital, Dhaka, over a period of 1year (July 2011-June 2012). Total 25 cases were selected according to inclusion criteria of colorectal carcinoma- anemia with abdominal lump, altered bowel habit, per rectal bleeding and positive DRE findings. For all cases, detailed history was taken by using predesigned data sheet. Informed consent was taken. All the cases examined thoroughly. Anemia, jaundice, edema, lymphadenopathy, abdominal signs-ascites, lump, hepatomegaly recorded. Per vaginal examination was done in female patients and per rectal examination done for all. USG of whole abdomen, double contrast barium enema, CT scan of whole abdomen and colonoscopy were done according to need and patient ability. Proctoscopic or colonoscopic biopsy was done for every case. All routine investigation done and informed written consent was taken. Operative findings were recorded and specimen sent for histopathology. Postoperative period monitored carefully and documented. Finally, all patients referred to oncologist for further management.

Results: The statistical data of the study presented in tabulated form

Table 1: Colorectal Carcinoma- Age, Sex and Site (n=25)

Table 2: Presentation of Colorectal Carcinoma according to Site (n=25)

Table 3: Correlation between Clinical and Laparotomy Findings (n=25)

Table 4: Operations Done for Lesions of Different Sites (n=25)

Table 5: Immediate Surgical Complications (n=25)

Maximum cases of colorectal cancer found in 3rd decade (44%; 11cases), followed by (20%; 5cases) in both 4th and 5th decade. Both Shaheb [5], and Shariff [6], reported maximum incidence was in 4th decade respectively 28% and 26%. The western study shows that, more than 90% of patients of colorectal cancer are over the age of 40years [7]. In this series overall male to female ratio was 2.12:1. Islam [8], reported male: female ratio 3:1, Shaheb [5], reported 3.17:1. In Spain, in women, the incidence is increasing comparable to men [9]. Predominance of female in our country they are from low socioeconomic status and from remote rural area, always neglected or showing less interest for their healthcare.

In this study the great share of the site distribution was occupied by the rectum and the recto-sigmoid junction (52%; 13cases), left colon (28%; 7cases) and right colon (20%; 5cases). Sharrif [6], also viewed rectum is the most common site in our country. In a Nigerian data rectal carcinoma (56%) was more common than colon carcinoma (44%) [10]. Also a study of Thailand, rectal carcinoma is more common (53.13%) [11]. In this series, vast majority of right sided lesion presented with weakness and weight loss and anemia. On the other hand, features of altered bowel habit and per rectal bleeding were more common in left sided lesion. All the rectal and recto-sigmoid cases had positive DRE.

Most of the patients having anemia (80%, 20 cases) in this study is due to malnourishment, poverty etc. which superimposed on the disease process.

In this study clinical diagnosis (preoperative) and laparotomy findings (operative) differed mainly in fixity status. Mobile growth was found in 18cases (72%) clinically but per-operative freely mobile growth was present in 15cases (60%). Para colic lymph node and liver metastasis could not be detectable clinically but liver metastasis was found in 1case operatively.

Surgical resection is one of the treatment options for colorectal carcinoma, so the therapeutic approach was exclusively surgical in this series. Curative resection had been possible in 15cases (60%). Palliative resection done in 5cases (20%), palliative end colostomy in 1case (4%) and diverting loop colostomy in 4cases (16%). Nesbakken et al. [12], reported, out of 49 cases of distal colorectal carcinoma, 9(18.3%) APR was done. Khot et al. [13], showed, 10-30% of patients with colon cancer presented with obstruction and palliation was achieved in 302(90%) of 336 cases.

Out of 25 patients 3cases (12%) developed wound infection and 1case (4%) developed fecal fistula. In contrast to western studies, none of the patients developed deep vein thrombosis and respiratory tract infection. This may have the explanation that in western world, people are more obese than our country.

The study was a single centered study with a limited catchments area which does not represents all the patients of the country.

In western study, Colorectal carcinoma occur in aged person like 50 years or more but in our country colorectal carcinoma is more common in younger people like below 35. For improve cure rate early diagnosis is essential. There is need to increase awareness about the malignancy and its management, also implementation of colonoscopy facility. We must use all available procedure, continue screening program, thus early detection and treatment of colorectal carcinoma can increase the higher survival rate in patients.

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