A patient of age 50 yrs presented with lower abdominal pain, blood in stools with difficulty opening bowels, and anaemia(Hb - 8gm/dl). The patient had no significant past medical history and had attained menopause. Patient had a flexible sigmoidoscopy, which revealed an sigmoid colon lesion with narrowing in the bowel. Whilst biopsies were awaited, patient had undergone staging CT scan, which confirmed sigmoid colon lesion which had localised inflammatory changes and was reported to be close to right ovary and urinary bladder region, there were no other significant lesions in the lungs, liver or rest of the abdomen. With the suspicion of cancerous lesion of colon and with impending bowel obstruction, patient and her family were explained and consented for laparoscopic anterior resection surgery, with a potential for temporary stoma.

At the beginning of surgery, on laparoscopy, it was noted that the sigmoid colon was densely adherent to the urinary bladder, but the ovaries and uterus were not involved. Patient underwent laparoscopic anterior resection or sigmoid colon resection along with excision of a cuff of urinary bladder which was removed en-masse with the colon cancer. The urinary bladder defect was closed in two layers. Colon to rectum, bowel anastomosis was performed. The urinary catheter was instructed to stay till 3weekstimepostoperatively.Patient hadan uneventfulrecovery, andwasdischargedhomeonPOD4.

Patient had developed UTI 2 weeks after discharging home, which was managed with change of urine catheter and oral antibiotics. In the third week with urology review and a cystogram, we confirmed healing of urinary bladder repair and the catheter was removed.

The histopathology report confirmed the sigmoid colon cancer(adenocarcinoma) to be advanced but fortunately the adhesion to urinary bladder was only cancer related inflammatory reaction (desmoplastic reaction) and the cancer was fully removed from the body and as the lymph nodes showed some cancer cells in them, and IHC MSI assessment showed the tumor to be MSI stable, patient was advised adjuvant chemotherapy.The post-operative clinic review confirmed full recovery of patient, with normal hemoglobin, normal bowel habits with good appetite.