P4734 - Pushing Out More Than a Baby: Delivery of Rectosigmoid Adenocarcinoma

Award: ACG Presidential Poster Award

Jinye Liu, DO¹, Abdulazeez Swaiti, MD¹, Christin Wilkinson, MD¹, Clarimar Diaz-Lopez, MD², Rami Basmaci, MD¹, Parnita Kesar, MD¹, Alessandra Martorella, DO³, M Danial Ali Shah, MD⁴, Aryan Jain, MBA, BS⁵, Khaled M.. Elhusseiny, MD¹, Sarah RT. Jahangir, MD⁶, Romina Nomigolzar, MD⁷, Deniz Coskuner, MD⁶, Taruj , MD¹, Christina Santana, MD¹, Kena Lemu, MS¹, Stephanie Ibarra Lepe, MD¹, Saeed S. Graham, MD⁸, Kara Regan, MD⁹
1East Carolina University Medical Center, Greenville, NC; 2East Carolina University Medical Center, Greenville, FL; 3MedStar Georgetown University Hospital, Washington, DC; 4Western Michigan University, Kalamazoo, MI; 5Albany Medical Center, Albany, NY; 6ECU Health Medical Center, Greenville, NC; 7ECU Health medical center, Greenville, NC; 8ECU Department of Internal Medicine, Greenville, NC; 9East Carolina Gastroenterology, Greenville, NC

Introduction:

Colorectal cancer (CRC) screening with colonoscopy remains the gold standard for diagnosing benign polyps to malignancies, with well-established guidelines focused on age and risk stratification. CRC in pregnancy is extremely rare, only occurring in around 0.002% of women of pregnancy. This incidence has increased as maternal age is on the rise as well as an increase in early-onset CRC. Symptoms of CRC such as constipation, nausea, or rectal discomfort may be misattributed to normal physiologic changes in pregnancy, potentially delaying diagnosis. We present a patient with an unusual discovery of CRC during labor, highlighting the diagnostic challenges and life-saving potential of incidental discovery.

Case Description/

Methods: A 30-year-old female with no past medical history underwent an uncomplicated vaginal delivery. During delivery, she expelled what appeared to be a polyp protruding from the rectum. The 2 cm specimen was sent for pathology review and revealed a tubular adenoma with high grade dysplasia. Subsequent colonoscopy one week later showed internal hemorrhoids and a 2.5 cm polyp in the rectosigmoid region, removed with a cold snare. Pathology revealed an invasive, moderate to poorly differentiated adenocarcinoma arising within a villous adenoma. Serum CEA was 0.5. Staging CT of the abdomen and pelvis showed no metastatic disease. The tumor was staged as pT1. The patient endorsed intermittent constipation and nausea during her pregnancy but otherwise denied occult bleeding, systemic complaints, or a family history of colon cancer or other GI malignancies. Follow-up surveillance with alternating EUS and MRI yielded no disease recurrence.

Discussion: There are only a few published cases describing incidental polyp discovery during labor and delivery, and even fewer with an established diagnosis of invasive adenocarcinoma. In this case, the diagnosis was made in a patient without identifiable risk factors and well below the recommended CRC screening age; the malignancy may have otherwise gone undetected, possibly making the discovery life-saving. This case also highlights how normal GI physiology of pregnancy (such as nausea, altered bowel habits) may be easily misattributed, further emphasizing how CRC can remain clinically silent even at invasive stages. Finally, this case highlights the importance of maintaining a high index of suspicion in atypical situations. Malignancy may present in the most unexpected of ways, and vigilance is quintessential to lead to early detection.


Figure: Figure 1. A and B demonstrating the mass in the sigmoid. C revealing the site after cold snare resection. D showing three clips placed over the resection region, with tattooing (in blue).


Figure: Figure 2. Follow-up surveillance demonstrating scar site with NBI (A) and without (B). Yellow arrow pointing to scar site on EUS (C).


Disclosures:
Jinye Liu indicated no relevant financial relationships.
Abdulazeez Swaiti indicated no relevant financial relationships.
Christin Wilkinson indicated no relevant financial relationships.
Clarimar Diaz-Lopez indicated no relevant financial relationships.
Rami Basmaci indicated no relevant financial relationships.
Parnita Kesar indicated no relevant financial relationships.
Alessandra Martorella indicated no relevant financial relationships.
M Danial Ali Shah indicated no relevant financial relationships.
Aryan Jain indicated no relevant financial relationships.
Khaled Elhusseiny indicated no relevant financial relationships.
Sarah Jahangir indicated no relevant financial relationships.
Romina Nomigolzar indicated no relevant financial relationships.
Deniz Coskuner indicated no relevant financial relationships.
Taruj indicated no relevant financial relationships.
Christina Santana indicated no relevant financial relationships.
Kena Lemu indicated no relevant financial relationships.
Stephanie Ibarra Lepe indicated no relevant financial relationships.
Saeed Graham indicated no relevant financial relationships.
Kara Regan indicated no relevant financial relationships.

Jinye Liu, DO¹, Abdulazeez Swaiti, MD¹, Christin Wilkinson, MD¹, Clarimar Diaz-Lopez, MD², Rami Basmaci, MD¹, Parnita Kesar, MD¹, Alessandra Martorella, DO³, M Danial Ali Shah, MD⁴, Aryan Jain, MBA, BS⁵, Khaled M.. Elhusseiny, MD¹, Sarah RT. Jahangir, MD⁶, Romina Nomigolzar, MD⁷, Deniz Coskuner, MD⁶, Taruj , MD¹, Christina Santana, MD¹, Kena Lemu, MS¹, Stephanie Ibarra Lepe, MD¹, Saeed S. Graham, MD⁸, Kara Regan, MD⁹. P4734 - Pushing Out More Than a Baby: Delivery of Rectosigmoid Adenocarcinoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.