Mucous Fistula and End Colostomy for Emergency Management of Septic Large Bowel Obstruction in a Patient With Rectal Cancer: A Case Report.

Obstructing rectal cancer complicated by sepsis represents a surgical emergency. When definitive oncologic resection is not feasible, alternative diversion strategies are required to safely decompress the bowel and control sepsis. We report the case of a 67-year-old woman with known rectal adenocarcinoma who presented in septic shock due to distal large bowel obstruction. Intraoperative evaluation revealed a completely obstructing fungating rectal mass that precluded Hartmann's procedure or diverting loop colostomy. Emergent diversion with an end colostomy and concomitant mucous fistula was performed to decompress the excluded distal bowel segment and prevent mucofecal accumulation and perforation. This case highlights mucous fistula creation as a viable and underutilized adjunct in the emergency management of obstructing rectal cancer when standard diversion or resection is not appropriate. Early shared decision-making and timely definitive management of rectal cancer may reduce the risk of high-acuity emergent presentations.