Synchronous Multiple Primary Malignant Adenocarcinoma of the Descending Colon and Fungating Bleeding Adenocarcinoma of the Terminal Ileum Presenting Massive Rectal Bleeding: A Trap for the Unwary

Sep 21, 2026

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Primary ileal cancer is rare, and co-occurrence with primary colon cancer is even more uncommon, making accurate diagnosis before surgery particularly difficult. This case report describes an exceptionally infrequent presentation: ruptured primary ileal adenocarcinoma combined with primary descending colon cancer causing gastrointestinal bleeding. Preoperatively, bleeding was suspected to originate from a descending colon lesion, but intraoperative exploration showed the bleeding source was a terminal ileal mass. After surgical treatment, the patient recovered satisfactorily. The report emphasizes complete gastrointestinal exploration during haemorrhage, especially for urgent surgery, and recommends intraoperative pathology and appropriate resections when adenocarcinoma is confirmed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Introduction

Case Presentation

Received, Accepted, Published

OncoTargets and Therapy Dovepress open access to scientific and medical research Open Access Full Text Article C ASE REPORT Synchronous Multiple Primary Malignant Adenocarcinoma of the Descending Colon and Fungating Bleeding Adenocarcinoma of the Terminal Ileum Presenting Massive Rectal Bleeding: A Trap for the Unwary Baicheng Li*, Zhao Chen*, Guangzhi Wang, Yaqing Liu, Shili Ning Department of General Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, 116023, People’s Republic of China *These authors contributed equally to this work Correspondence: Shili Ning, Department of General Surgery, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, Liaoning Province, 116023, People’s Republic of China, Tel +86-0411-84671291, Email [ningshili2008@163.com](ningshili2008@163.com) | Abstract: Primary cancer of the ileum is rare, and when it occurs in conjunction with primary colon cancer, it becomes even more infrequent and challenging to diagnose prior to surgical intervention. Primary small bowel cancers can be overlooked and may be misidentified as small bowel mesenchymal tumours or advanced metastases from colon cancer. We present an exceedingly uncommon case of ruptured primary ileal cancer combined with primary descending colon cancer presenting with gastrointestinal bleeding. Based on our understanding, instances of dual tumours concurrently occurring are exceedingly infrequent. In this patient, there was a preoperative suspicion of bleeding from colon cancer in the descending region. However, intraoperative exploration revealed that the location of the bleeding was a terminal ileal mass. Following the surgical intervention, the patient recovered satisfactorily. Intraoperative exploration of the entire gastrointestinal tract is therefore necessary in patients with gastrointestinal haemorrhage, especially in those who require urgent surgery without adequate preoperative investigations. If a mass is detected at the end of the ileum, intraoperative pathology should be performed if feasible. Subsequently, if the diagnosis reveals an adenocarcinoma, terminal ileocolic resection and right hemicolectomy are necessary for appropriate resection.
Keywords: multiple primary malignant neoplasms, gut bleeding, adenocarcinoma of the small bowel, descending colon cancer, gastrointestinal tumours, case report | | --- | | Introduction
Multiple primary malignant neoplasms (MPMNs) are multiple primary tumours that occur simultaneously or heterochronously at different sites in the same patient and may occur throughout the body.1 For the diagnosis of multiple primary tumours, it is very easy to miss a diagnosis when the tumours occur at the same time, and it is easy tomisdiagnose metastatic cancer when they occur at different times. The duodenum and jejunum are the most common sites for small bowel adenocarcinoma, whereas small bowel adenocarcinoma in the distal ileum is rare.2 Due to the infrequency of small bowel cancer cases, lesions of the small bowel occasionally become overlooked during gastrointestinal surgery due to lack of examination of the small intestine during surgery, leading to the failure to diagnose small bowel cancer.3 The diagnosis of ileal adenocarcinoma was almost completely missed in this patient.
This case report describes a patient with primary ileal cancer combined with primary descending colon cancer that was associated with ileal cancer rupture and bleeding. In this patient, there was a preoperative suspicion of bleeding from a colon cancer lesion in the descending region. However, intraoperative exploration revealed that the location of the | Received: 4 January 2024 Accepted: 9 April 2024 Published: 2 May 2024 OncoTargets and Therapy 2024:17 363–368 363 © 2024 Li et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at [https://www.dovepress.com/terms.php](http

FAQs

What should clinicians do when an ileal mass is found during emergency surgery?

If feasible, perform intraoperative pathology. If the diagnosis is adenocarcinoma, terminal ileocolic resection and right hemicolectomy are necessary for appropriate resection.

Sep 21, 2026

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