Would you continue treatment of a rectal metastasis in a patient who is found to have radiographic evidence of contained rectal perforation during the treatment?

Good clinical question. In my experience, I have treated quite a few of both rectal and anal cancer cases, but not one from a metastatic nature that I can recall.

But, in any event, my clinical instincts/experienced would push me to ask the following questions:

Is this a change in his my daily/weekly portal imaging that suggest a rectal "new" perforation, my instinct would be to examined him to make sure he/she does not have an evolving acute belly that needs to go the ER for evaluation ----->

Either way, I would get the surgical service involved right away to let them judge the necessity of intestinal diverting procedure, or not. Actually, I would have had them, the surgeons, signoff upfront before intervening just for their initial surgic...