RECURRENT RECTAL CANCER COMPLICATED WITH PERFORATION AND NECROTISING FASCIITIS DURING NEOADJUVANT THERAPY

INTRODUCTION: RECTAL CANCER LOCAL RECURRENCE IS LESS FREQUENT SINCE MULTIDISCIPLINARY APPROACH HAS BEEN IMPLEMENTED, USUALLY TME EXCISION BEING PERFORMED AFTER NEOADJUVANT THERAPY. IN CASE OF RECURRENCE, NEOADJUVANT THERAPY, INCLUDING STANDARD DOSE RADIOTHERAPY SHOULD BE CONSIDERED IF NOT PERFORMED INITIALLY. PATIENTS PREVIOUSLY IRRADIATED, CAN BENEFIT OF LOWER-DOSES RE-IRRADIATION CONCOMITANT WITH CHEMOTHERAPY, FACILITATING A CURATIVE SURGICAL RESECTION. CASE REPORT: IT IS PRESENTED THE CASE OF A 68 YEARS OLD PATIENT, WHO PERFORMED A RECTAL ANTERIOR RESECTION WITH COLO-RECTAL ANASTOMOSIS FOR RECTAL TUMOR 4 YEARS BEFORE IN ANOTHER MEDICAL UNIT. THE PATIENT IS DIAGNOSED WITH RECURRENCE INVOLVING THE ANASTOMOSIS, FOR WHICH MULTIDISCIPLINARY TEAM RECOMMENDED RADIOCHEMOTHERAPY PRIOR TO SURGERY. DURING THE NEOADJUVANT THERAPY, BEFORE THE LAST CHEMOTHERAPY CURES THE PATIENT IS EMERGENCY SUBMITTED TO SURGERY SERVICE FOR INFLAMMATORY TUMEFACTION WITH NECROTISING FASIITIS IN THE RIGHT ISCHIORECTAL FOSSA. A FIRST SURGERY CONSISTING IN DRAINAGE AND EXTENSIVE DEBRIDEMENT ALSO OBESERVES RECTAL WALL PERFORATION. A SECOND IMMEDIATE INTERVETION CONSISTING IN A TERMINAL COLOSTOMY IS PERFORMED. AFTER ANTIBIOTHERAPY, LOCAL DRESSINGS, AND SEPTIC CONTROL OF THE WOUND AN ABDOMINO- ERINEAL SALVAGE RESECTION IS DONE, AN IMPORTANT SKIN DEFECT REMAINING. CONCLUSION: A QUICK AND EFICCIENT MANAGEMENT OF A SEVERE CONDITION PERMITTED NOT ONLY TO CONTROL A LIFE THREATENING SITUATION , BUT ALSO PERFORMING AN ABDOMINO-PERINEAL RESECTION. A MORE OFTEN OR MAYBE ROUTINELY USE OF DIVERTING COLOSTOMY BEFORE RADIOCHEMOTHERAPY SHOULD BE CONSIDERED IN CASE OF RECURRENT RECTAL CANCER, DETAILED STUDIES BEING NECESSARY ON THIS ASPECT

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