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General Rehabilitation

A Stroke of Bad Luck: A Case of Colon Cancer Diagnosed During Stroke Rehabilitation

Thursday, November 16, 2023
Case Diagnosis: 48-year-old man diagnosed with colon cancer while undergoing inpatient stroke rehabilitation

Case Description or Program Description: The patient was admitted to the Inpatient Rehabilitation Facility (IRF) following a right middle cerebral artery stroke for which he underwent mechanical thrombectomy and subsequent decompressive craniectomy. His course was complicated by deep vein thrombosis for which treatment with apixaban was initiated. While on the rehabilitation unit, he was noted to have black, tarry stools, prompting gastroenterology consultation.  The stool changes were initially attributed to his anticoagulation, but inpatient endoscopy and colonoscopy were performed after his hemoglobin level decreased.

Setting: Inpatient Rehabilitation Facility (IRF)

Assessment/Results: The colonoscopy revealed a transverse colonic mass. He was transferred to the colorectal surgery service and underwent laparascopic colectomy. The mass removed was 6.8 cm in diameter, and pathology confirmed colon adenocarcinoma.  His cancer was stage IIC.  He subsequently returned to the IRF to complete his course of rehabilitation. Ultimately, he was discharged home with family support and close follow-up.

Discussion (relevance): Patients receiving stroke rehabilitation are often on antiplatelet and/or anticoagulant medications that increase their risk for gastrointestinal (GI) bleeding.  It is, however, essential to consider GI malignancy in the differential for melena.  It is important to note that the incidence of colon cancer is on the rise among adults under the age of 55 years, and that persons with colon cancer have a higher incidence of stroke than the general population.

Conclusions: Early detection of colon cancer facilitates prompt treatment and better outcomes.  One must rule out GI malignancy in the event of bleeding, even when it occurs in an individual receiving medications that increase their bleeding risk following stroke.