Laparoscopic Low Anterior Resection for Rectal Cancer in a Patient With Rectal Varices Secondary to Metabolic Dysfunction-Associated Steatohepatitis-Related Cirrhosis: A Case Report

Rectal varices (RVs) are a known complication of portal hypertension in patients with liver cirrhosis; however, the coexistence of rectal cancer and RVs in the setting of metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis is rare. Herein, we report the successful laparoscopic management of rectal cancer complicated by RVs in an 80-year-old woman with Child-Pugh class A cirrhosis. A colonoscopy revealed rectal adenocarcinoma with surrounding varices. Given the patient's preserved hepatic function, we performed laparoscopic low anterior resection without preoperative variceal interventions. To minimize intraoperative bleeding, early ligation of the inferior mesenteric vein, ligation of the proximal mesenteric vein supplying the varices, and clipping and division of all visible mesenteric veins within the mesorectum were carried out. Postoperatively, portal hypertension was effectively managed with diuretics, and the patient recovered without complications or recurrent bleeding. This case demonstrates a feasible surgical strategy focused on vascular control in patients with rectal cancer, RVs, and compensated cirrhosis, offering valuable insight for managing similarly complex cases.