Rectal Adenocarcinoma in Crohnʼs Disease: A Case Report 3062

This is a case of a 21 year old male patient who underwent total colectomy and a colostomy for a long standing and extensive Crohns disease who developed rectal adenocarcinoma and eventually expired. In Crohn's disease, cancer risk data is limited. If colorectal cancer does develop, however, th...

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Published inThe American journal of gastroenterology Vol. 113; no. Supplement; pp. S1673 - S1674
Main Authors Juvvala, Kavitha, Bank, Leslie, Scagnelli, Gregory
Format Journal Article
LanguageEnglish
Published New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
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Abstract This is a case of a 21 year old male patient who underwent total colectomy and a colostomy for a long standing and extensive Crohns disease who developed rectal adenocarcinoma and eventually expired. In Crohn's disease, cancer risk data is limited. If colorectal cancer does develop, however, the prognosis is recognized to be poor with reduced survival.This 21 year old male presented to our clinic in 2007 at age 13 who was diagnosed with Crohn disease at age 7.His medical history is remarkable with 4 to 5 blood transfusions for anemia, growth hormone deficiency, hypogonadism, vitamin D deficiency and a stable pituitary microadenoma. He was managed with numerous courses of steroids, antimetabolites such as infliximab, certolizumab and 5ASA.His Colonoscopy in 2008 revealed complete loss of vascularity and large pseudo polyps, biopsy was consistent with markedly active chronic colitis with crypt distortion in the colon, marked acute ileitis and acute chronic inflammation in the stomach supporting the diagnosis of Crohn disease .Despite aggressive medical management , his symptoms continued to progress and was hesitant to have an ileostomy over the years .In august 2014 he has failed all medications and was placed on Entyvio.He was having flare ups and recurrent pelvic and abdominal abscess with partial bowel obstruction, perforation of the ileum likely contributed to the abscess and impending fistula. His routine colonoscopy procedure was not successful as there was a large rectal mass which was consistent with malignancy and the biopsy of the rectal mass showed a poorly differentiated infiltrating adenocarcinoma .So, he had diagnostic laparoscopy converted to exploratory laparotomy, extensive lysis of abdomen and pelvic adhesions, drainage of pelvic and abdominal abscesses, ileocectomy and colostomy, eventually deteriorated and expired with rectal adenocarcinoma.Colorectal cancer represents the major cause for excess morbidity and mortality by malignant disease in ulcerative colitis as well as in Crohns disease. Younger patients with long-standing Crohns disease should be considered for colonic surveillance to permit earlier diagnosis and treatment of potential colorectal carcinoma. Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis. Colonoscopy every 1 to 2 years with biopsies for dysplasia.
AbstractList This is a case of a 21 year old male patient who underwent total colectomy and a colostomy for a long standing and extensive Crohns disease who developed rectal adenocarcinoma and eventually expired. In Crohn's disease, cancer risk data is limited. If colorectal cancer does develop, however, the prognosis is recognized to be poor with reduced survival.This 21 year old male presented to our clinic in 2007 at age 13 who was diagnosed with Crohn disease at age 7.His medical history is remarkable with 4 to 5 blood transfusions for anemia, growth hormone deficiency, hypogonadism, vitamin D deficiency and a stable pituitary microadenoma. He was managed with numerous courses of steroids, antimetabolites such as infliximab, certolizumab and 5ASA.His Colonoscopy in 2008 revealed complete loss of vascularity and large pseudo polyps, biopsy was consistent with markedly active chronic colitis with crypt distortion in the colon, marked acute ileitis and acute chronic inflammation in the stomach supporting the diagnosis of Crohn disease .Despite aggressive medical management , his symptoms continued to progress and was hesitant to have an ileostomy over the years .In august 2014 he has failed all medications and was placed on Entyvio.He was having flare ups and recurrent pelvic and abdominal abscess with partial bowel obstruction, perforation of the ileum likely contributed to the abscess and impending fistula. His routine colonoscopy procedure was not successful as there was a large rectal mass which was consistent with malignancy and the biopsy of the rectal mass showed a poorly differentiated infiltrating adenocarcinoma .So, he had diagnostic laparoscopy converted to exploratory laparotomy, extensive lysis of abdomen and pelvic adhesions, drainage of pelvic and abdominal abscesses, ileocectomy and colostomy, eventually deteriorated and expired with rectal adenocarcinoma.Colorectal cancer represents the major cause for excess morbidity and mortality by malignant disease in ulcerative colitis as well as in Crohns disease. Younger patients with long-standing Crohns disease should be considered for colonic surveillance to permit earlier diagnosis and treatment of potential colorectal carcinoma. Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis. Colonoscopy every 1 to 2 years with biopsies for dysplasia.
Author Scagnelli, Gregory
Juvvala, Kavitha
Bank, Leslie
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Snippet This is a case of a 21 year old male patient who underwent total colectomy and a colostomy for a long standing and extensive Crohns disease who developed...
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StartPage S1673
SubjectTerms Abdomen
Abscesses
Biopsy
Case reports
Colonoscopy
Colorectal cancer
Crohn's disease
Gastroenterology
Inflammatory bowel disease
Medical prognosis
Ostomy
Subtitle 3062
Title Rectal Adenocarcinoma in Crohnʼs Disease: A Case Report
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Volume 113
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