A Case Report of Anastomotic Recurrence after Restorative Proctocolectomy with Hand-sewn Ileal Pouch Anal Anastomosis for Ulcerative Colitis with Colitic Cancer

• Published in: Nippon Daicho Komonbyo Gakkai Zasshi Vol. 66; no. 1; pp. 49 - 55
• Main Authors: Saito, Kenichiro, Munemoto, Yoshinori, Takashima, Yoshihiro, Amaya, Susumu, Iida, Yoshiro
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Coloproctology 2013
• ISSN: 0047-1801; 1882-9619
• DOI: 10.3862/jcoloproctology.66.49

The patient was a 58-year-old woman who had been diagnosed as having left-sided ulcerative colitis at the age of 40. She had been diagnosed with colitic cancer in the sigmoid colon by surveillance colonoscopy, and had undergone a restorative proctocolectomy with hand-sewn ileal pouch anal anastomosis at the age of 56. The histopathological diagnosis was advanced colon cancer, type 4, muc>tub2>por, se, n (-) ; dysplasia was seen only around the cancer lesion. She had an onset of ileus caused by anastomotic recurrence without distant metastasis. We performed abdominoperineal resection of the ileal pouch. The histopathological diagnosis was recurrent colon cancer, por-sig>muc, n+ (15/20). We considered peritoneal dissemination may have been the recurrence mechanism because the invasion depth of the primary tumor exposed the serosa, with poorly differentiated adenocarcinoma as the histological type, and because the recurrent tumor mainly invaded under the epithelium. Even after restorative proctocolectomy with mucosectomy, surveillance endoscopy is necessary for postoperative patients with colitic cancer.