{"id":80987,"date":"2025-05-09T16:41:28","date_gmt":"2025-05-09T14:41:28","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=80987"},"modified":"2025-05-08T08:17:35","modified_gmt":"2025-05-08T06:17:35","slug":"cancer-colorrectal-con-perforacion-intestinal","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/cancer-colorrectal-con-perforacion-intestinal\/","title":{"rendered":"C\u00e1ncer colorrectal con perforaci\u00f3n intestinal"},"content":{"rendered":"

C\u00e1ncer colorrectal con perforaci\u00f3n intestinal<\/strong><\/p>\n

Autora principal:<\/strong> Lorena Dom\u00ednguez Cuevas<\/p>\n

Vol. XX; n\u00ba 09; 445<\/p>\n

Colorectal cancer with intestinal perforation<\/strong><\/p>\n

Fecha de recepci\u00f3n:<\/strong> 19 de febrero de 2025
\nFecha de aceptaci\u00f3n:<\/strong> 7 de mayo de 2025<\/p>\n

Incluido en Revista Electr\u00f3nica de PortalesMedicos.com Volumen XX. N\u00famero 09 Primera quincena de mayo de 2025 \u2013 P\u00e1gina inicial: Vol. XX; n\u00ba 09; 445<\/p>\n

\u00a0<\/strong><\/p>\n

Autores: <\/strong>Lorena Dom\u00ednguez Cuevas; Alba Cirac Oriol; Pedro Roberto Sancho Ortega; Mar\u00eda Ester Cano Serrano; Sheila Larrayad Sanz; Angie Yurani Ramos de los R\u00edos; Roc\u00edo del Pilar P\u00e9rez Orozco.<\/p>\n

Centro de Trabajo actual: <\/strong>Hospital Cl\u00ednico Universitario \u201cLozano Blesa\u201d de Zaragoza (Espa\u00f1a)<\/p>\n

Palabras clave en espa\u00f1ol: <\/strong>c\u00e1ncer, colorrectal, perforaci\u00f3n, intestinal, peritonitis<\/p>\n

Palabras clave en ingl\u00e9s: <\/strong>cancer, colorectal, perforation, intestinal, peritonitis, bowel<\/p>\n

Resumen en espa\u00f1ol: <\/strong><\/p>\n

Se presenta el caso de un paciente masculino de 68 a\u00f1os con diagn\u00f3stico reciente de c\u00e1ncer colorrectal en estadio avanzado, quien ingres\u00f3 al hospital debido a un dolor abdominal intenso, fiebre y distensi\u00f3n abdominal. En los estudios de imagen se identific\u00f3 una perforaci\u00f3n intestinal secundaria a la neoplasia en el colon sigmoide. La perforaci\u00f3n caus\u00f3 peritonitis difusa, y la paciente fue sometida a una cirug\u00eda de emergencia para realizar una colectom\u00eda parcial y lavado peritoneal. Tras la intervenci\u00f3n quir\u00fargica, se inici\u00f3 un r\u00e9gimen de quimioterapia adyuvante, ya que el tumor mostr\u00f3 signos de diseminaci\u00f3n local. La paciente evolucion\u00f3 favorablemente postoperatoriamente, y fue dada de alta con un plan de seguimiento estrecho. El pron\u00f3stico se considera reservado debido al estadio avanzado del c\u00e1ncer, y se considera un tratamiento paliativo dependiendo de la respuesta del paciente.<\/p>\n

 <\/p>\n

Resumen en ingl\u00e9s: <\/strong><\/p>\n

We present the case of a 68-year-old male patient recently diagnosed with advanced stage colorectal cancer, who was admitted to hospital due to severe abdominal pain, fever and abdominal distension. Imaging studies identified an intestinal perforation secondary to the neoplasm in the sigmoid colon. The perforation caused diffuse peritonitis, and the patient underwent emergency surgery for partial colectomy and peritoneal lavage. After surgery, an adjuvant chemotherapy regimen was started, as the tumour showed signs of local dissemination. The patient progressed favourably postoperatively and was discharged with a close follow-up plan. The prognosis is considered guarded due to the advanced stage of the cancer, and palliative treatment is considered depending on the patient’s response.<\/p>\n

 <\/p>\n

Los autores de este manuscrito declaran que:<\/p>\n

Todos ellos han participado en su elaboraci\u00f3n y no tienen conflictos de intereses
\nLa investigaci\u00f3n se ha realizado siguiendo las Pautas \u00e9ticas internacionales para la investigaci\u00f3n relacionada con la salud con seres humanos elaboradas por el Consejo de Organizaciones Internacionales de las Ciencias M\u00e9dicas (CIOMS) en colaboraci\u00f3n con la Organizaci\u00f3n Mundial de la Salud (OMS).
\nEl manuscrito es original y no contiene plagio.
\nEl manuscrito no ha sido publicado en ning\u00fan medio y no est\u00e1 en proceso de revisi\u00f3n en otra revista.
\nHan obtenido los permisos necesarios para las im\u00e1genes y gr\u00e1ficos utilizados.
\nHan preservado las identidades de los pacientes.<\/p>\n

 <\/p>\n

Caso Cl\u00ednico: <\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

Motivo de consulta<\/strong>:
\n<\/strong>Paciente masculino de 68 a\u00f1os, con antecedentes de hipertensi\u00f3n arterial y tabaquismo cr\u00f3nico, que acude a urgencias por dolor abdominal intenso en el cuadrante inferior izquierdo, asociado a fiebre, distensi\u00f3n abdominal y n\u00e1useas persistentes durante las \u00faltimas 24 horas. Refiere que el dolor aument\u00f3 de intensidad en las \u00faltimas horas y se acompa\u00f1\u00f3 de v\u00f3mitos fecaloides.<\/p>\n

 <\/p>\n

Historia cl\u00ednica<\/strong>:
\n<\/strong>El paciente tiene antecedentes de cambios en el h\u00e1bito intestinal con episodios de diarrea y estre\u00f1imiento alternados, sin diagn\u00f3stico previo de enfermedades gastrointestinales graves. En la exploraci\u00f3n f\u00edsica, se observa distensi\u00f3n abdominal significativa, sensibilidad a la palpaci\u00f3n profunda, especialmente en el cuadrante inferior izquierdo, y signos de irritaci\u00f3n peritoneal. Se observa taquicardia y fiebre de 38\u00b0C.<\/p>\n

\u00a0<\/strong><\/p>\n

Pruebas diagn\u00f3sticas<\/strong>:
\n<\/strong>Se realiz\u00f3 una tomograf\u00eda computarizada (TC) de abdomen que mostr\u00f3 una masa en el colon sigmoide y una perforaci\u00f3n intestinal con extravasaci\u00f3n de aire hacia la cavidad peritoneal, confirmando una peritonitis difusa. La colonoscopia revel\u00f3 un tumor obstructivo en la misma regi\u00f3n. La biopsia del tumor identific\u00f3 adenocarcinoma colorrectal. El an\u00e1lisis de sangre mostr\u00f3 leucocitosis con neutrofilia.<\/p>\n

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Tratamiento<\/strong>:
\n<\/strong>Debido a la perforaci\u00f3n intestinal y la peritonitis, el paciente fue sometido a cirug\u00eda de emergencia, realizando una colectom\u00eda parcial con anastomosis de la porci\u00f3n proximal al recto. Se realiz\u00f3 lavado peritoneal para limpiar la cavidad. Posteriormente, se inici\u00f3 tratamiento con quimioterapia adyuvante, utilizando un esquema de 5-fluorouracilo (5-FU) y oxaliplatino. El paciente tambi\u00e9n recibi\u00f3 antibi\u00f3ticos para controlar la infecci\u00f3n peritoneal.<\/p>\n

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Pron\u00f3stico<\/strong>:
\n<\/strong>El pron\u00f3stico del paciente es reservado debido al estadio avanzado del c\u00e1ncer y la presencia de perforaci\u00f3n intestinal, que representa una complicaci\u00f3n grave. La intervenci\u00f3n quir\u00fargica mejor\u00f3 la situaci\u00f3n aguda, pero la diseminaci\u00f3n local del tumor limita las opciones curativas. El tratamiento se centrar\u00e1 en el manejo sintom\u00e1tico y la quimioterapia adyuvante, con un pron\u00f3stico que depender\u00e1 de la respuesta del tumor al tratamiento y de la aparici\u00f3n de met\u00e1stasis.<\/p>\n

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Seguimiento<\/strong>:
\n<\/strong>El paciente fue dado de alta con un plan de seguimiento estrecho, que incluye visitas mensuales para la monitorizaci\u00f3n de la funci\u00f3n intestinal, control de los efectos secundarios de la quimioterapia, y evaluaci\u00f3n de la respuesta tumoral mediante im\u00e1genes y marcadores tumorales. Se plane\u00f3 un seguimiento a largo plazo para detectar posibles recidivas o met\u00e1stasis.<\/p>\n

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Discusi\u00f3n<\/strong>:
\n<\/strong>La perforaci\u00f3n intestinal es una complicaci\u00f3n grave en el c\u00e1ncer colorrectal avanzado, asociada a un mal pron\u00f3stico. La peritonitis resultante requiere un manejo quir\u00fargico urgente, con la extirpaci\u00f3n del segmento afectado y el control de la infecci\u00f3n. El tratamiento de c\u00e1ncer colorrectal avanzado incluye cirug\u00eda, quimioterapia y cuidados paliativos, con la intenci\u00f3n de mejorar la calidad de vida y prolongar la supervivencia. Sin embargo, la mortalidad sigue siendo alta debido a la diseminaci\u00f3n local y a las complicaciones asociadas. La detecci\u00f3n temprana de complicaciones, como la perforaci\u00f3n, es fundamental para mejorar los resultados cl\u00ednicos.<\/p>\n

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Bibliograf\u00eda: <\/strong><\/p>\n

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