A retrospective descriptive study of emergency presentation and surgical management of colorectal cancer

Background and objectives. Colorectal cancer (CRC) is one of the leading causes of cancer-related death in Iraq, where no nationwide screening programs exist. Data on emergency presentations and surgical outcomes are limited. This study aimed to describe the clinical manifestations and surgical management of colorectal cancer in patients presenting emergently in Basrah, southern Iraq. Patients and methods. Between September 2021 and September 2023, 37 patients were identified from 300 colorectal cancer cases admitted to Al-Sadr Teaching Hospital and Basrah Oncology Center. Patients presented with acute symptoms, including intestinal obstruction, perforation, rectal bleeding, anemia, and generalized weakness. All underwent diagnostic evaluation, including colonoscopy, tumor markers, and imaging. Surgical and oncological management were recorded. Results. Of 37 patients, 23 were male (62.2%) and 14 female (37.8%). The most common presentation was partial intestinal obstruction (46%), followed by complete obstruction (13.5%), perforation (13.5%), and rectal bleeding (13.5%). Adenocarcinoma and mucinous adenocarcinoma were the predominant histological subtypes. Surgical resection with primary anastomosis was performed in 24 patients, resection with colostomy in 5, and resection with double stomas in 2. Two patients were deemed inoperable, 2 refused surgery and received neoadjuvant chemoradiotherapy, and 2 declined all treatment. Conclusion. Emergency presentation of colorectal cancer remains common in Basrah, reflecting delays in diagnosis and the absence of systematic screening. Implementation of early detection and population-based screening strategies is essential to reduce emergency admissions and improve outcomes.