Managing Large Bowel Obstruction From Colorectal Cancer in the Presence of Multiorgan Hydatid Disease: A Multidisciplinary Challenge

Managing Large Bowel Obstruction From Colorectal Cancer in the Presence of Multiorgan Hydatid Disease: A Multidisciplinary Challenge | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Managing Large Bowel Obstruction From Colorectal Cancer in the Presence of Multiorgan Hydatid Disease: A Multidisciplinary Challenge Oussama Shibly, Elias El Hajj, Elissar Mansour, Ilige Abdallah, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8513284/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 17 You are reading this latest preprint version Abstract Large bowel obstruction may represent a surgical emergency due to the risk of sepsis and hemodynamic instability, particularly given the underlying etiologies such as colorectal malignancies. Hydatid cyst mainly occurs in the liver and may migrate to other organs, particularly the lungs. It may remain asymptomatic for years, often discovered incidentally during abdominal ultrasound. Coexistence of colorectal cancer and hydatid cyst is a rare phenomenon, which when presenting, demands close cooperation of surgical, oncological and infectious diseases specialties to ensure proper management. This report presents a case of large bowel obstruction found to be caused by colorectal cancer in a patient with known hepatic and pulmonary hydatid cyst. Clinical presentation, diagnosis, surgical procedures are reviewed with emphasis on the importance of multidisciplinary collaboration in rare-dual pathology to ensure appropriate management and avoid unintended multi-therapeutic interactions. Large Bowel Obstruction Hydatid cyst Colorectal Cancer Multidisciplinary coordination Figures Figure 1 Figure 2 Figure 3 Introduction Large bowel obstruction can present acutely as a result of hernia, volvulus, diverticular strictures and colorectal adenocarcinoma, and may constitute an emergency due to the of risk of sepsis, ischemia, dehydration, hemodynamic instability ( 1 ). Large bowel obstruction presentation varies with the level of obstruction, but primarily includes abdominal pain and distention, which may be the first indication of colorectal carcinoma - particularly in the descending colon, sigmoid or rectum ( 2 ). Management of colorectal carcinoma depends on multiple factors including tumor resectability and generally involves surgical removal and adjuvant therapies ( 3 ). Hydatid cyst are caused by echinococcus granulosum larval stage, typically acquired through the ingestion of eggs discharged in feces of infected dogs. The infection may remain asymptomatic for years, with clinical manifestation depending on the location and size of the cyst. Hydatid cyst most commonly develop in the liver, causing weight loss, stomach pain and jaundice, and it may disseminate to other organs, typically to the lungs, manifesting as chest pain, dyspnea and cough ( 4 ). Thus it is not uncommon to detect the presence of cysts in both these organs simultaneously ( 5 ). Pulmonary hydatid cysts are notably faster growing than hepatic cysts due to lungs’s elasticity and negative intrathoracic pressure. The diagnosis of hydatid cyst is established via a combination of clinical presentation and radiological imaging. Surgical removal is the ultimate treatment, with different conservative approaches applied to hepatic versus pulmonary hydatid cyst, and particular care given for the maintenance of lung parenchyma integrity. As for medical therapy, Albendazole is preferably withheld till after the surgery, as to not weaken the cyst wall risking rupture, nevertheless, antiparasitic therapy remains an essential component of the treatment to prevent recurrence, and the only treatment option in inoperable cases ( 5 , 6 ). The coexistence of hydatid cyst and colorectal cancer is a rare occurrence that demands close multidisciplinary coordination ( 7 ). Our case is that of a known pulmonary and hepatic hydatid cyst, presenting with acute large bowel obstruction ultimately attributed to colorectal carcinoma. It explores the rare concomitant existence of hydatid cyst and colorectal carcinoma and its implications for the simultaneous management of both conditions. Case Presentation A 48 year-old female non-smoker, non-alcoholic, with a past medical history of hydatid cysts in the liver and lung, diabetes, dyslipidemia on atorvastatin and a past surgical history of thoracotomy for hydatid cysts in the right lung one month prior to presentation, presented to the ER with a sudden onset of epigastric pain associated with obstipation, abdominal distention, and several episodes of bilious vomiting several days prior to presentation. Upon admission, vitals were stable and within the normal range. Physical examination revealed a distended abdomen, absence of bowel movement, and a generalized abdominal tenderness. Initial laboratory findings showed elevated white blood cell (WBC) count at 12 x10 9 cells/L, Elevated neutrophil count at 89%, elevated C-reactive protein (CRP) at 6 mg/L, slightly low hemoglobin at 11.1 g/dL, and a slightly low platelet count at 235 cells/L. An abdominal and pelvic CT scan ( Fig. 1 ) revealed multiple hepatic cystic lesions with internal membranes and septations consistent with hydatid cysts seen later on laparoscopically ( Fig. 2 ) with no calcifications. Moreover, imaging showed severe colonic dilatation of the sigmoid colon (9cm in diameter) and cecum (13 cm in diameter), fecal loading with transitional zone noted in the distal sigmoid colon ( Fig. 3 ) , and an irregular soft tissue lesions with internal calcifications (approximately 2*2 cm). Further investigation via colonoscopy was recommended to rule out malignancy. The patient was given pain management medication, with a nasogastric tube that yielded 400 mL of bilious fluid and IV hydration to maintain fluid balance and prevent dehydration. Subsequently, a rectal sigmoidoscopy was performed, and a polylobed polyp was resected using a diathermic loop at the rectosigmoid junction. The colonoscopy also revealed a large stenosing ulcerative budding tumor about 25 cm from anal margin. Therefore, the patient underwent laparoscopic surgery under general anesthesia to dissect Todt's fascia until reaching a good length of the colonic loop, a left lateral colostomy was done as a result. Postoperatively, 1 g of Augmentin was administered on day one. The following day, the nasogastric tube was removed. After confirming the passage of stool and gas, a clear fluid diet was started, and later discharged home. Pathology revealed tubulovillous adenoma with carcinoma in situ lesions, and a free polyp axis without any signs of invasion of the pedicle or section slice. Non-invasive carcinoma in situ was confirmed. A full colonoscopy through the colostomy orifice to the cecum was performed 14 days post-operatively, no polyps or tumor were detected, progression in a second stage through the same orifice toward the tumor (15 cm away from the colostomy) did not reveal any polyp or tumor, however laboratory results indicated significantly elevated levels of CEA 153 ng/mL (normal is less that 5 ng/mL). 1 week later after colonoscopy, part of the rectosigmoid colon and the left uterine adnexa were removed laparoscopically. Post operation, on day one patient was kept on nothing by mouth and the patient was put on Rocephine 2g, Flagyl 500mg. On day two, Foley was removed and started on clear fluids. On day five the drain had an output of 50 ml of serous fluid, stable vitals, and a soft non tender abdomen. The patient was discharged home. Pathology identified a moderately differentiated adenocarcinoma, infiltrating the wall up to the serosa PT4, vascular invasion and perineural sheathing, a tumor budding score = 3, absence of lymph node metastasis (0/14) and surgical limits were free. As post-surgical follow up, Infectious disease physician and oncologist were consulted, the patient was started on chemotherapy to prevent disease progression, and the patient started albendazole to treat the hydatid cysts. Discussion A 48-year-old female presents a complex case of coexistence between hydatid cysts and colorectal cancer. The patient presented with symptoms of epigastric pain, obstipation, and abdominal distention, revealing possible large bowel obstruction. Imaging showed severe colonic dilatation in the distal sigmoid colon, and an irregular soft tissue mass with calcifications suggestive of a tumor. Moreover, previous history of hydatid cysts in the liver and lungs (caused by parasitic tapeworm echinococcus) added to the complexity of the case. However, in this patient the mass was colorectal malignancy as revealed by the biopsy and the CEA levels. The coexistence of hydatid cysts and colorectal cancer is quite rare but can be indicative of a potential link between prior history of hydatid cyst and the development of malignancies. Although no clear evidence links echinococcosis to colorectal cancer, the malignancy could have been a repercussion of the chronic inflammation caused by the hydatid cysts. Previous literature describes a patient with colorectal liver cancer and hydatid cysts ( 8 ), however a direct causality remains speculative. The patient’s CEA levels of 153, and pathology confirmed moderately differentiated colonic adenocarcinoma with tumor budding, vascular invasion, and perineural sheathing. The dilemma arises in the management of the cancer and the hydatid cysts simultaneously. Furthermore, ( 7 ) reveals that in case of a diagnosis of hydatid cysts with cancer (although a rare phenomenon) it is recommended to treat each condition separately as their coexistence does not affect their outcome, additionally the cyst should be treated according to its stage and the cancer treatment’s timing and initiation should not be altered. Consequently, chemotherapy combined with albendazole were used as treatment with no further complication during follow up. The patient had surgery in stages; emergency decompression and colostomy, then final oncologic excision when the blockage was cleared. This approach is in keeping with colorectal surgery and National Comprehensive Cancer Network (NCCN) guidelines, which suggest avoiding primary anastomosis when the integrity of the intestinal wall is compromised or there is significant colonic dilatation. When the danger of anastomotic leak is high (cecal dilatation > 12 cm considerably increases perforation risk), phased procedures are used while ensuring the best possible health for the patient before undergoing final cancer surgery. Since the patient had a high-grade obstruction and the colon was noticeably enlarged, the initial diversion was a suitable and recommended course of action. Concerns about possible problems during immunosuppressive treatment were raised by the patient's active hepatic hydatid cysts. However, current literature suggests that chemotherapy can be given safely when hydatid illness is treated concurrently with antiparasitic medication. Several cancer patients with calcified and active hepatic hydatid cysts who received albendazole and systemic chemotherapy did not have cyst rupture, infection, or accelerated cyst growth ( 7 ). These findings imply that, in the majority of cases, immunosuppression has little effect on cyst behavior. This validates an increasingly prevalent opinion in the literature: the presence of hydatid illness should not be the only reason to postpone the oncologic urgency, provided that: According to the World Health Organization Informal Working Group on Echinococcocis (WHO-IWGE) classification, cysts are appropriately staged. When necessary, albendazole medication is started, and throughout their treatment, patients are radiologically monitored. Conclusion This case highlights the importance of multidisciplinary collaboration in management of concurrent infectious and oncologic conditions -specifically hydatid cyst and colorectal cancer- as to avoid unwanted drug interaction and treatment-related complications that may compromise patient’s immunity. This also underscores the importance of patient-centered, personalized care approach. Declarations In accordance to the declaration of Helsinki our research was conducted Ethics approval and consent to participate: Ethics committee at Haykel hospital approved this study. Consent Patient in this manuscript has given written informed consent to publication of his case details. Competing interests The authors declare that they have no competing interests. Funding No funding available. Author Contribution Conceptualization, Michael El Khoury; writing—original draft preparation, Michael El Khoury, Oussama Shibly, Elias El Hajj, Elissar Mansour, Ilige Abdallah, Philippe Attieh; writing—review and editing , Michael El Khoury, Oussama Shibly, Elias El Hajj, Elissar Mansour, Ilige Abdallah, Philippe Attieh ; supervision, Michael El Khoury ; project administration, Michael El Khoury. All authors have read and agreed to the published version of the manuscript. Acknowledgements: The authors would like to acknowledge Haykel hospital and the Department of Biomedical Sciences, Faculty of Medicine and Medical Sciences, University of Balamand, Al-Koura, Lebanon, for their support. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Chen KA, Kapadia MR. Large Bowel Obstruction: Etiologies, Diagnosis, and Management. Clin Colon Rectal Surg. 2024;37(06):376–80. Lieske B, Marietta M, Meseeha M. Large Bowel Obstruction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Dec 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441888/ Fadlallah H, El Masri J, Fakhereddine H, Youssef J, Chemaly C, Doughan S, et al. Colorectal cancer: Recent advances in management and treatment. World J Clin Oncol. 2024;15(9):1136–56. Badwaik N, Gharde P, Shinde RK, Tayade H, Navandhar PS, Patil M. Hydatid Cyst or Echinococcosis: A Comprehensive Review of Transmission, Clinical Manifestations, Diagnosis, and Multidisciplinary Treatment. Cureus [Internet]. 2024 Jul 2 [cited 2025 Dec 25]; Available from: https://www.cureus.com/articles/260274-hydatid-cyst-or-echinococcosis-a-comprehensive-review-of-transmission-clinical-manifestations-diagnosis-and-multidisciplinary-treatment Kabiri EH, El Hammoumi M, Bhairis M. Single-stage versus two-stage surgery of pulmonaryand hepatic hydatid cysts. Pol J Cardio-Thorac Surg. 2021;18(3):139–44. Aydın Y, Ali Bilal U, Dostbil A. Current Management of Pulmonary Hydatid Cyst. Eurasian J Med. 2025;57(1):1–7. Shabani S, Shabani S, Zarinfar Y. Hydatid cyst management and follow-up in cancer patient [Internet]. 2024 [cited 2025 Dec 25]. Available from: https://www.authorea.com/users/474564/articles/728174-hydatid-cyst-management-and-follow-up-in-cancer-patient?commit=7d3827e941e694859c26c0070112487241b9e090 Zedelj J, Petrovic I, Pavlek G, Moric T, Romic M, Silovski H, et al. Concomitant Presence of Hydatid Cyst and Colorectal Liver Metastasis. Turk J Parasitol. 2021;45(2):146–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 06 Apr, 2026 Reviewers agreed at journal 17 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers agreed at journal 15 Feb, 2026 Reviewers agreed at journal 14 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers invited by journal 28 Jan, 2026 Editor invited by journal 08 Jan, 2026 Editor assigned by journal 08 Jan, 2026 Submission checks completed at journal 08 Jan, 2026 First submitted to journal 04 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8513284","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":582080562,"identity":"04ff1ba6-e189-416d-988e-4c43a8ecc903","order_by":0,"name":"Oussama Shibly","email":"","orcid":"","institution":"University of Balamand","correspondingAuthor":false,"prefix":"","firstName":"Oussama","middleName":"","lastName":"Shibly","suffix":""},{"id":582080563,"identity":"f23adac1-dcbe-45f1-aefc-04b63ac079af","order_by":1,"name":"Elias El Hajj","email":"","orcid":"","institution":"University of 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calcifications.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8513284/v1/20d4692f5ff929ef9d98ffc8.jpeg"},{"id":101507842,"identity":"f39bb5f7-2d10-4af6-95ca-5102f6cb1d6b","added_by":"auto","created_at":"2026-01-30 14:42:59","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":464277,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple hepatic cystic lesions identified laparoscopically (Blue arrows).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8513284/v1/aacadb373b2a4a7da00a0293.jpeg"},{"id":101507847,"identity":"1d71d568-0bad-4e95-a672-36969df64902","added_by":"auto","created_at":"2026-01-30 14:43:00","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":627665,"visible":true,"origin":"","legend":"\u003cp\u003eCT scan showing severe colonic dilatation of the sigmoid colon (9cm in diameter) and cecum (13 cm in diameter), fecal loading with transitional zone noted in the distal sigmoid colon (blue arrow), and an irregular soft tissue lesions with internal calcifications (approximately 2*2 cm)\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8513284/v1/3a2e0c1431e3f309586b7ba9.jpeg"},{"id":101755210,"identity":"bb62fac5-434c-4380-9da2-d819ac166e4f","added_by":"auto","created_at":"2026-02-03 10:49:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1526990,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8513284/v1/39ea1304-b953-467e-8886-299a73f1855f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Managing Large Bowel Obstruction From Colorectal Cancer in the Presence of Multiorgan Hydatid Disease: A Multidisciplinary Challenge","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLarge bowel obstruction can present acutely as a result of hernia, volvulus, diverticular strictures and colorectal adenocarcinoma, and may constitute an emergency due to the of risk of sepsis, ischemia, dehydration, hemodynamic instability (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Large bowel obstruction presentation varies with the level of obstruction, but primarily includes abdominal pain and distention, which may be the first indication of colorectal carcinoma - particularly in the descending colon, sigmoid or rectum (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Management of colorectal carcinoma depends on multiple factors including tumor resectability and generally involves surgical removal and adjuvant therapies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHydatid cyst are caused by echinococcus granulosum larval stage, typically acquired through the ingestion of eggs discharged in feces of infected dogs. The infection may remain asymptomatic for years, with clinical manifestation depending on the location and size of the cyst. Hydatid cyst most commonly develop in the liver, causing weight loss, stomach pain and jaundice, and it may disseminate to other organs, typically to the lungs, manifesting as chest pain, dyspnea and cough (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Thus it is not uncommon to detect the presence of cysts in both these organs simultaneously (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Pulmonary hydatid cysts are notably faster growing than hepatic cysts due to lungs\u0026rsquo;s elasticity and negative intrathoracic pressure. The diagnosis of hydatid cyst is established via a combination of clinical presentation and radiological imaging. Surgical removal is the ultimate treatment, with different conservative approaches applied to hepatic versus pulmonary hydatid cyst, and particular care given for the maintenance of lung parenchyma integrity. As for medical therapy, Albendazole is preferably withheld till after the surgery, as to not weaken the cyst wall risking rupture, nevertheless, antiparasitic therapy remains an essential component of the treatment to prevent recurrence, and the only treatment option in inoperable cases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe coexistence of hydatid cyst and colorectal cancer is a rare occurrence that demands close multidisciplinary coordination (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Our case is that of a known pulmonary and hepatic hydatid cyst, presenting with acute large bowel obstruction ultimately attributed to colorectal carcinoma. It explores the rare concomitant existence of hydatid cyst and colorectal carcinoma and its implications for the simultaneous management of both conditions.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 48 year-old female non-smoker, non-alcoholic, with a past medical history of hydatid cysts in the liver and lung, diabetes, dyslipidemia on atorvastatin and a past surgical history of thoracotomy for hydatid cysts in the right lung one month prior to presentation, presented to the ER with a sudden onset of epigastric pain associated with obstipation, abdominal distention, and several episodes of bilious vomiting several days prior to presentation. Upon admission, vitals were stable and within the normal range. Physical examination revealed a distended abdomen, absence of bowel movement, and a generalized abdominal tenderness. Initial laboratory findings showed elevated white blood cell (WBC) count at 12 x10\u003csup\u003e9\u003c/sup\u003e cells/L, Elevated neutrophil count at 89%, elevated C-reactive protein (CRP) at 6 mg/L, slightly low hemoglobin at 11.1 g/dL, and a slightly low platelet count at 235 cells/L. An abdominal and pelvic CT scan \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e revealed multiple hepatic cystic lesions with internal membranes and septations consistent with hydatid cysts seen later on laparoscopically \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e with no calcifications. Moreover, imaging showed severe colonic dilatation of the sigmoid colon (9cm in diameter) and cecum (13 cm in diameter), fecal loading with transitional zone noted in the distal sigmoid colon \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, and an irregular soft tissue lesions with internal calcifications (approximately 2*2 cm). Further investigation via colonoscopy was recommended to rule out malignancy. The patient was given pain management medication, with a nasogastric tube that yielded 400 mL of bilious fluid and IV hydration to maintain fluid balance and prevent dehydration. Subsequently, a rectal sigmoidoscopy was performed, and a polylobed polyp was resected using a diathermic loop at the rectosigmoid junction. The colonoscopy also revealed a large stenosing ulcerative budding tumor about 25 cm from anal margin. Therefore, the patient underwent laparoscopic surgery under general anesthesia to dissect Todt's fascia until reaching a good length of the colonic loop, a left lateral colostomy was done as a result. Postoperatively, 1 g of Augmentin was administered on day one. The following day, the nasogastric tube was removed. After confirming the passage of stool and gas, a clear fluid diet was started, and later discharged home. Pathology revealed tubulovillous adenoma with carcinoma in situ lesions, and a free polyp axis without any signs of invasion of the pedicle or section slice. Non-invasive carcinoma in situ was confirmed. A full colonoscopy through the colostomy orifice to the cecum was performed 14 days post-operatively, no polyps or tumor were detected, progression in a second stage through the same orifice toward the tumor (15 cm away from the colostomy) did not reveal any polyp or tumor, however laboratory results indicated significantly elevated levels of CEA 153 ng/mL (normal is less that 5 ng/mL). 1 week later after colonoscopy, part of the rectosigmoid colon and the left uterine adnexa were removed laparoscopically. Post operation, on day one patient was kept on nothing by mouth and the patient was put on Rocephine 2g, Flagyl 500mg. On day two, Foley was removed and started on clear fluids. On day five the drain had an output of 50 ml of serous fluid, stable vitals, and a soft non tender abdomen. The patient was discharged home. Pathology identified a moderately differentiated adenocarcinoma, infiltrating the wall up to the serosa PT4, vascular invasion and perineural sheathing, a tumor budding score\u0026thinsp;=\u0026thinsp;3, absence of lymph node metastasis (0/14) and surgical limits were free. As post-surgical follow up, Infectious disease physician and oncologist were consulted, the patient was started on chemotherapy to prevent disease progression, and the patient started albendazole to treat the hydatid cysts.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eA 48-year-old female presents a complex case of coexistence between hydatid cysts and colorectal cancer. The patient presented with symptoms of epigastric pain, obstipation, and abdominal distention, revealing possible large bowel obstruction. Imaging showed severe colonic dilatation in the distal sigmoid colon, and an irregular soft tissue mass with calcifications suggestive of a tumor. Moreover, previous history of hydatid cysts in the liver and lungs (caused by parasitic tapeworm echinococcus) added to the complexity of the case. However, in this patient the mass was colorectal malignancy as revealed by the biopsy and the CEA levels.\u003c/p\u003e \u003cp\u003eThe coexistence of hydatid cysts and colorectal cancer is quite rare but can be indicative of a potential link between prior history of hydatid cyst and the development of malignancies. Although no clear evidence links echinococcosis to colorectal cancer, the malignancy could have been a repercussion of the chronic inflammation caused by the hydatid cysts. Previous literature describes a patient with colorectal liver cancer and hydatid cysts (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), however a direct causality remains speculative.\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s CEA levels of 153, and pathology confirmed moderately differentiated colonic adenocarcinoma with tumor budding, vascular invasion, and perineural sheathing. The dilemma arises in the management of the cancer and the hydatid cysts simultaneously. Furthermore, (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) reveals that in case of a diagnosis of hydatid cysts with cancer (although a rare phenomenon) it is recommended to treat each condition separately as their coexistence does not affect their outcome, additionally the cyst should be treated according to its stage and the cancer treatment\u0026rsquo;s timing and initiation should not be altered. Consequently, chemotherapy combined with albendazole were used as treatment with no further complication during follow up.\u003c/p\u003e \u003cp\u003eThe patient had surgery in stages; emergency decompression and colostomy, then final oncologic excision when the blockage was cleared. This approach is in keeping with colorectal surgery and National Comprehensive Cancer Network (NCCN) guidelines, which suggest avoiding primary anastomosis when the integrity of the intestinal wall is compromised or there is significant colonic dilatation. When the danger of anastomotic leak is high (cecal dilatation\u0026thinsp;\u0026gt;\u0026thinsp;12 cm considerably increases perforation risk), phased procedures are used while ensuring the best possible health for the patient before undergoing final cancer surgery. Since the patient had a high-grade obstruction and the colon was noticeably enlarged, the initial diversion was a suitable and recommended course of action.\u003c/p\u003e \u003cp\u003eConcerns about possible problems during immunosuppressive treatment were raised by the patient's active hepatic hydatid cysts. However, current literature suggests that chemotherapy can be given safely when hydatid illness is treated concurrently with antiparasitic medication. Several cancer patients with calcified and active hepatic hydatid cysts who received albendazole and systemic chemotherapy did not have cyst rupture, infection, or accelerated cyst growth (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These findings imply that, in the majority of cases, immunosuppression has little effect on cyst behavior. This validates an increasingly prevalent opinion in the literature: the presence of hydatid illness should not be the only reason to postpone the oncologic urgency, provided that: According to the World Health Organization Informal Working Group on Echinococcocis (WHO-IWGE) classification, cysts are appropriately staged. When necessary, albendazole medication is started, and throughout their treatment, patients are radiologically monitored.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the importance of multidisciplinary collaboration in management of concurrent infectious and oncologic conditions -specifically hydatid cyst and colorectal cancer- as to avoid unwanted drug interaction and treatment-related complications that may compromise patient\u0026rsquo;s immunity. This also underscores the importance of patient-centered, personalized care approach.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003eIn accordance to the declaration of Helsinki our research was conducted\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003eEthics committee at Haykel hospital approved this study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent\u003c/strong\u003e \u003cp\u003e Patient in this manuscript has given written informed consent to publication of his case details.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding available.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, Michael El Khoury; writing\u0026mdash;original draft preparation, Michael El Khoury, Oussama Shibly, Elias El Hajj, Elissar Mansour, Ilige Abdallah, Philippe Attieh; writing\u0026mdash;review and editing , Michael El Khoury, Oussama Shibly, Elias El Hajj, Elissar Mansour, Ilige Abdallah, Philippe Attieh ; supervision, Michael El Khoury ; project administration, Michael El Khoury. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThe authors would like to acknowledge Haykel hospital and the Department of Biomedical Sciences, Faculty of Medicine and Medical Sciences, University of Balamand, Al-Koura, Lebanon, for their support.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen KA, Kapadia MR. Large Bowel Obstruction: Etiologies, Diagnosis, and Management. Clin Colon Rectal Surg. 2024;37(06):376\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLieske B, Marietta M, Meseeha M. Large Bowel Obstruction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Dec 25]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK441888/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK441888/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFadlallah H, El Masri J, Fakhereddine H, Youssef J, Chemaly C, Doughan S, et al. Colorectal cancer: Recent advances in management and treatment. World J Clin Oncol. 2024;15(9):1136\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadwaik N, Gharde P, Shinde RK, Tayade H, Navandhar PS, Patil M. Hydatid Cyst or Echinococcosis: A Comprehensive Review of Transmission, Clinical Manifestations, Diagnosis, and Multidisciplinary Treatment. Cureus [Internet]. 2024 Jul 2 [cited 2025 Dec 25]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cureus.com/articles/260274-hydatid-cyst-or-echinococcosis-a-comprehensive-review-of-transmission-clinical-manifestations-diagnosis-and-multidisciplinary-treatment\u003c/span\u003e\u003cspan address=\"https://www.cureus.com/articles/260274-hydatid-cyst-or-echinococcosis-a-comprehensive-review-of-transmission-clinical-manifestations-diagnosis-and-multidisciplinary-treatment\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKabiri EH, El Hammoumi M, Bhairis M. Single-stage versus two-stage surgery of pulmonaryand hepatic hydatid cysts. Pol J Cardio-Thorac Surg. 2021;18(3):139\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydın Y, Ali Bilal U, Dostbil A. Current Management of Pulmonary Hydatid Cyst. Eurasian J Med. 2025;57(1):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShabani S, Shabani S, Zarinfar Y. Hydatid cyst management and follow-up in cancer patient [Internet]. 2024 [cited 2025 Dec 25]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.authorea.com/users/474564/articles/728174-hydatid-cyst-management-and-follow-up-in-cancer-patient?commit=7d3827e941e694859c26c0070112487241b9e090\u003c/span\u003e\u003cspan address=\"https://www.authorea.com/users/474564/articles/728174-hydatid-cyst-management-and-follow-up-in-cancer-patient?commit=7d3827e941e694859c26c0070112487241b9e090\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZedelj J, Petrovic I, Pavlek G, Moric T, Romic M, Silovski H, et al. Concomitant Presence of Hydatid Cyst and Colorectal Liver Metastasis. Turk J Parasitol. 2021;45(2):146\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Large Bowel Obstruction, Hydatid cyst, Colorectal Cancer, Multidisciplinary coordination","lastPublishedDoi":"10.21203/rs.3.rs-8513284/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8513284/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eLarge bowel obstruction may represent a surgical emergency due to the risk of sepsis and hemodynamic instability, particularly given the underlying etiologies such as colorectal malignancies. Hydatid cyst mainly occurs in the liver and may migrate to other organs, particularly the lungs. It may remain asymptomatic for years, often discovered incidentally during abdominal ultrasound. Coexistence of colorectal cancer and hydatid cyst is a rare phenomenon, which when presenting, demands close cooperation of surgical, oncological and infectious diseases specialties to ensure proper management. This report presents a case of large bowel obstruction found to be caused by colorectal cancer in a patient with known hepatic and pulmonary hydatid cyst. Clinical presentation, diagnosis, surgical procedures are reviewed with emphasis on the importance of multidisciplinary collaboration in rare-dual pathology to ensure appropriate management and avoid unintended multi-therapeutic interactions.\u003c/p\u003e","manuscriptTitle":"Managing Large Bowel Obstruction From Colorectal Cancer in the Presence of Multiorgan Hydatid Disease: A Multidisciplinary Challenge","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 14:41:59","doi":"10.21203/rs.3.rs-8513284/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-06T16:44:25+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"189699893393028536805743004950849327208","date":"2026-03-17T07:25:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T11:14:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218937180344858078077872158458120196956","date":"2026-03-10T08:11:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T16:03:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285671076939001304822234561317551773373","date":"2026-02-27T17:48:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333395566053587967119313017769511684983","date":"2026-02-26T03:27:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338484641119964913920764931409592849327","date":"2026-02-20T09:34:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270470951631630185194953883482151137567","date":"2026-02-15T05:33:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161147401179788820309561512285607855919","date":"2026-02-14T22:50:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T01:02:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227763344530472779958967417508098959697","date":"2026-01-28T23:41:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T19:42:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-08T17:21:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T09:50:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-08T09:46:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-01-04T13:19:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd22ed1e-ceb9-4c61-8f0d-c05762b2e30d","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T20:24:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 14:41:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8513284","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8513284","identity":"rs-8513284","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}