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Adenocarcinoma Arising Below an Ileoanal Anastomosis After Restorative Proctocolectomy for Ulcerative Colitis: Report of a Case

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We report a case of adenocarcinoma developing in remnant rectal mucosa below a hand-sewn ileal pouch–anal anastomosis (IPAA) after restorative proctocolectomy for ulcerative colitis (UC). To our knowledge, this is the first such case to be reported from Japan. A 60-year-old man with a 13-year history of UC underwent proctocolectomy with a hand-sewn IPAA and mucosectomy for anal stenosis and serious tenesmic symptoms. About 7 years later, a follow-up endoscopy showed a flat elevated malignant lesion, 2 cm in diameter, below the ileoanal anastomosis. He was treated by abdominoperineal resection of the pouch and anus with total mesorectal excision. Histopathological examination of the resected specimen confirmed the presence of a well-differentiated adenocarcinoma but there were no metastatic lymph nodes. He recovered uneventfully and remains well without evidence of recurrent disease 2 years and 3 months after his last operation.

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  1. MM Ravitch (1984) ArticleTitleThe reception of new operations Ann Surg 200 231–46 Occurrence Handle6380435 Occurrence Handle10.1097/00000658-198409000-00001 Occurrence Handle1:STN:280:BiuB2sbhs1M%3D

    Article  PubMed  CAS  Google Scholar 

  2. H Stern S Walfish B Mullen R Mcleod Z Cohen (1990) ArticleTitleCancer in an ileo-anal reservoir: a new complication? Gut 31 473–5 Occurrence Handle2338277 Occurrence Handle1:STN:280:By%2BB2cbnvF0%3D

    PubMed  CAS  Google Scholar 

  3. D Puthu N Rajan L Rao P Venugopal (1992) ArticleTitleCarcinoma of the rectal pouch following restorative proctocolectomy: report of a case Dis Colon Rectum 35 257–60 Occurrence Handle1740073 Occurrence Handle10.1007/BF02051019 Occurrence Handle1:STN:280:By2C2MrgtVY%3D

    Article  PubMed  CAS  Google Scholar 

  4. J Rodriguez-Sanjuan M Polavieja A Naranjo J Castillo (1995) ArticleTitleAdenocarcinoma in an ileal pouch for ulcerative colitis (letter) Dis Colon Rectum 38 779–80 Occurrence Handle7607045 Occurrence Handle10.1007/BF02048042 Occurrence Handle1:STN:280:ByqA3s7gvFA%3D

    Article  PubMed  CAS  Google Scholar 

  5. R Sequens (1997) ArticleTitleCancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch–anal anastomosis Int J Colorectal Dis 12 254–5 Occurrence Handle9272458 Occurrence Handle10.1007/s003840050100 Occurrence Handle1:STN:280:ByiH3MfkvVA%3D

    Article  PubMed  CAS  Google Scholar 

  6. M Vieth M Grunewald C Niemeyer M Stolte (1998) ArticleTitleAdenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative colitis Virchows Arch 433 281–4 Occurrence Handle9769133 Occurrence Handle10.1007/s004280050248 Occurrence Handle1:STN:280:DyaK1cvktVSluw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. T Iwama J Kamikawa T Higuchi K Yagi T Matsuzaki J Kanno et al. (2000) ArticleTitleDevelopment of invasive adenocarcinoma in a long-standing diverted ileal J-pouch for ulcerative colitis Dis Colon Rectum 43 101–4 Occurrence Handle10813131 Occurrence Handle10.1007/BF02237251 Occurrence Handle1:STN:280:DC%2BD3c3ntFaguw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. UA Heuschen G Heushen F Autschbach EH Allemeyer C Herfarth (2001) ArticleTitleAdenocarcinoma in the ileal pouch: late risk of cancer after restorative proctocolectomy Int J Colorect Dis 16 126–30 Occurrence Handle10.1007/s003840000276 Occurrence Handle1:STN:280:DC%2BD3M3mtlCnsQ%3D%3D

    Article  CAS  Google Scholar 

  9. S Baratsis F Hadjidimitriou M Christodoulou K Lariou (2002) ArticleTitleAdenocarcinoma in the anal canal after ileal pouch–anal anastomosis for ulcerative colitis using a double stapling technique Dis Colon Rectum 45 687–92 Occurrence Handle12004221 Occurrence Handle10.1007/s10350-004-6268-z

    Article  PubMed  Google Scholar 

  10. N Hyman (2002) ArticleTitleRectal cancer as a complication of stapled IPAA Inflamm Bowel Dis 8 43–5 Occurrence Handle11837937 Occurrence Handle10.1097/00054725-200201000-00006

    Article  PubMed  Google Scholar 

  11. S Laureti F Ugolin A D’Errico S Rago G Poggioli (2002) ArticleTitleAdenocarcinoma below ileoanal anastomosis for ulcerative colitis. Report of a case and review of the literature Dis Colon Rectum 45 418–21 Occurrence Handle12068206 Occurrence Handle10.1007/s10350-004-6194-0 Occurrence Handle1:STN:280:DC%2BD38zisFKnsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. WS Bell B Parry M Neil (2003) ArticleTitleAdenocarcinoma in the anal transitional zone after ileal pouch for ulcerative colitis Dis Colon Rectum 46 1134–7 Occurrence Handle12907913 Occurrence Handle10.1007/s10350-004-7293-7

    Article  PubMed  Google Scholar 

  13. BS Ooi FH Remzi T Gramlich JM Church M Preen VW Fazio (2003) ArticleTitleAnal transitional zone cancer after proctocolectomy and ileoanal anastomosis in familial adenomatous polyposis Dis Colon Rectum 46 1418–23 Occurrence Handle14530685 Occurrence Handle10.1007/s10350-004-6760-5

    Article  PubMed  Google Scholar 

  14. JA Eaden KR Abrams JF Mayberry (2001) ArticleTitleThe risk of colorectal cancer in ulcerative colitis: a meta-analysis Gut 48 526–35 Occurrence Handle11247898 Occurrence Handle10.1136/gut.48.4.526 Occurrence Handle1:STN:280:DC%2BD3M3hs1Orsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. RP O’Connell JH Pemberton LH Weiland RW Beart SuffixJr RR Dozois BG Wolff et al. (1987) ArticleTitleDoes rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum 30 1–5 Occurrence Handle3803100 Occurrence Handle10.1007/BF02556908 Occurrence Handle1:STN:280:BiiC3cvovFI%3D

    Article  PubMed  CAS  Google Scholar 

  16. A Tsunoda IC Talbot RJ Nicholas (1990) ArticleTitleIncidence of dysplasia in the anorectal mucosa in patients having restorative proctocolectomy Br J Surg 77 506–8 Occurrence Handle2162229 Occurrence Handle10.1002/bjs.1800770510 Occurrence Handle1:STN:280:By%2BB1czms1A%3D

    Article  PubMed  CAS  Google Scholar 

  17. MG O’Riordain VW Fazio IC Lavery F Remzi N Fabbri J Meneu et al. (2000) ArticleTitleIncidence and natural history of dysplasia of the anal transitional zone after ileal pouch–anal anastomosis Dis Colon Rectum 43 1660–5 Occurrence Handle11156448 Occurrence Handle10.1007/BF02236846 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGrtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  18. FH Remzi VW Fazio PC Delaney M Preen A Ormsby J Bast et al. (2003) ArticleTitleDysplasia of the anal transitional zone after ileal pouch–anal anastomosis: Results of prospective evaluation after a minimum of ten years Dis Colon Rectum 46 6–13 Occurrence Handle12544515 Occurrence Handle10.1007/s10350-004-6488-2

    Article  PubMed  Google Scholar 

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Ota, H., Yamazaki, K., Endoh, W. et al. Adenocarcinoma Arising Below an Ileoanal Anastomosis After Restorative Proctocolectomy for Ulcerative Colitis: Report of a Case. Surg Today 37, 596–599 (2007).

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