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Adenocarcinoma arising from a strictureplasty site in Crohn's disease

Report of a case

  • Case Reports
  • Published:
Diseases of the Colon & Rectum

Abstract

The occurrence of small-bowel cancer in Crohn's disease (CD) is a rare event. The risk seems to be greatest in patients with long-standing disease. Strictureplasty has proved to be a valuable alternative in the management of Crohn's strictures of the small-bowel. Critics and proponents of strictureplasty for selected patients with smallbowel Crohn's disease have voiced their concerns about cancer risk in the strictured or strictureplasty site. To date, there has been no clear or detailed report of such an occurrence. The authors report the first case of small-bowel adenocarcinoma arising at the site of a previous strictureplasty. In this patient, biopsies of the strictures at the original operation confirmed CD and excluded both cancer and dysplasia. Malignancy occurred seven years later at a strictureplasty site. The main clinical sign associated with the adenocarcinoma was severe, persistent anemia. The authors conclude that the risk of adenocarcinoma developing at the site of a previous strictureplasty for CD, although small, is real.

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References

  1. Sharif H, Alexander-Williams J. The role of strictureplasty in Crohn's disease. Int Surg 1992;77:15–8.

    PubMed  Google Scholar 

  2. Sayfan J, Wilson DA, Allan A, Andrews H, Alexander-Williams J. Recurrence after strictureplasty for Crohn's disease. Br J Surg 1989;76:335–8.

    PubMed  Google Scholar 

  3. Tjandra JJ, Fazio VW. Strictureplasty without concomitant resection for small bowel obstruction in Crohn's disease. Br J Surg 1994;81:561–3.

    PubMed  Google Scholar 

  4. Ribeiro MB, Greenstein AJ, Heiman TM, Yamazaki Y, Aufses AH Jr. Adenocarcinoma of the small intestine in Crohn's Disease. Surg Gynecol Obstet 1991;36:654–61.

    Google Scholar 

  5. Hoffman JP, Taft DA, Wheelis JH, Walker JH. Adenocarcinoma in regional enteritis of the small intestine. Arch Surg 1977;112:606–11.

    PubMed  Google Scholar 

  6. Ginzburg L, Schneider KM, Dreizin DH, Levinson C. Carcinoma of the jejunum occurring in a case of regional enteritis. Surgery 1956;39:347–51.

    PubMed  Google Scholar 

  7. Michelassi F, Testa G, Pomidor WJ, Lashner BA. Adenocarcinoma complicating Crohn's disease. Dis Colon Rectum 1993;36:654–61.

    PubMed  Google Scholar 

  8. Persson PG, Karlen P, Bernell O,et al. Crohn's disease and cancer: a population-based cohort study. Gastroenterology 1994;107:1675–9.

    PubMed  Google Scholar 

  9. Munkholm P, Langholz E, Davidsen M, Binder V. Intestinal cancer risk and mortality in patients with Crohn's disease. Gastroenterology 1993;105:1716–23.

    PubMed  Google Scholar 

  10. Hawker PC, Gyde SN, Thompson H, Allan N. Adenocarcinoma of the small intestine complicating Crohn's disease. Gut 1982;23:188–93.

    PubMed  Google Scholar 

  11. Ekbom A, Helmick C, Zack M, Adami HO. Extracolonic malignancies in inflammatory bowel disease. Cancer 1991;67:2015–9.

    PubMed  Google Scholar 

  12. Alexander-Williams J, Haynes IG. Up-to-date management of small-bowel Crohn's disease. Adv Surg 1987;20:245–64.

    PubMed  Google Scholar 

  13. Ellamushi HE, Mith IS. Small bowel carcinoma complicating Crohn's disease. Scott Med J 1992;37:54–5.

    PubMed  Google Scholar 

  14. Bastug DF, Cochran RC, Caldwell R, Foster D. Adenocarcinoma of the small intestine in Crohn's disease: a unique finding. West Va Med J 1991;87:295–8.

    Google Scholar 

  15. Eitan B, Zisman I, Qarawany M, Grishkam A, Mazor A. Crohn's disease of the small bowel manifested by obstructive carcinoma. Harefuah 1993;125:209–11.

    PubMed  Google Scholar 

  16. Slezak P, Rubio C, Blomqvist L, Nakano H, Befrits R. Duodenal adenocarcinoma in Crohn's disease of the small bowel: a case report. Gastrointest Radiol 1991;16:15–7.

    PubMed  Google Scholar 

  17. Chen CC, Neugut AI, Rotterdam H. Risk factors for adenocarcinomas and malignant carcinoids of the small intestine: preliminary findings. Cancer Epidemiol Biomarkers Prev 1994;3:205–7.

    PubMed  Google Scholar 

  18. Del Prete P, Almerigi P, Tonielli E,et al. Adenocarcinoma of the distal ileal loop: a rare disease at the typical site for Crohn's disease. G Chir 1991;12:41–5.

    PubMed  Google Scholar 

  19. Watanabe M, Nakano H, Takano E, Miyachi I, Ito M, Kawase K. A case of small bowel carcinoma in Crohn's disease. Gastroenterol Jpn 1991;26:514–22.

    PubMed  Google Scholar 

  20. Crotta S, Cerrato C, Sansonna F, Allieta R, Parini U, Chasseur D. Ileal adenocarcinoma in Crohn's disease: a report of 2 cases. Minerva Gastroenterol Dietol 1992;38:211–6.

    PubMed  Google Scholar 

  21. Oertli D, Rothenbuhler JM, Harder F. Carcinoma of the small intestine in Crohn's disease: case report and review of the literature. Chirurg 1993;64:346–8.

    PubMed  Google Scholar 

  22. Alexander-Williams J, Haynes IG. Conservative operations for Crohn's disease of the small bowel. World J Surg 1985;9:945–51.

    PubMed  Google Scholar 

  23. Alexander-Williams J. Inflammatory bowel disease revisited: surgery today and tomorrow. Scand J Gastroenterol 1990;25:107–12.

    Google Scholar 

  24. Greenstein AJ, Sachar D, Pucillo A,et al. Cancer in Crohn's disease after diversionary surgery: a report of seven carcinomas occurring in excluded bowel. Am J Surg 1978;135:86–90.

    PubMed  Google Scholar 

  25. Flemming KA, Pollock AC. A case of “Crohn's carcinoma”. Gut 1975;16:533–7.

    PubMed  Google Scholar 

  26. Sachar DB. Cancer in Crohn's disease: dispelling the myths. Gut 1994;35:1507–8.

    PubMed  Google Scholar 

  27. Lashner BA. Risk factors for small bowel cancer in Crohn's disease. Dig Dis Sci 1992;37:1179–84.

    PubMed  Google Scholar 

  28. Alexander-Williams J, Fornaro M. Strictureplasty beim morbus Crohn. Chirurg 1982;53:799–801.

    PubMed  Google Scholar 

  29. Fazio VW, Tjandra JJ. Strictureplasty for Crohn's disease with multiple long strictures. Dis Colon Rectum 1993;36:71–2.

    PubMed  Google Scholar 

  30. Michelassi F. Side-to-side isoperistaltic strictureplasty for multiple Crohn's strictures. Dis Colon Rectum 1996;39:345–9.

    PubMed  Google Scholar 

  31. Ozuner G, Fazio VW, Lavery IC, Church JM, Hull TL. The role of strictureplasty in the management of Crohn's disease: how safe is it? Am J Surg 1996;171:57–61.

    PubMed  Google Scholar 

  32. Fazio VW, Tjandra JJ, Lavery IC, Church JM, Milsom JW, Oakley JR. Long-term follow-up of strictureplasty in Crohn's disease. Dis Colon Rectum 1993;36:355–61.

    PubMed  Google Scholar 

  33. Alexander-Williams J. Surgical management of small intestinal Crohn's disease: resection or strictureplasty. Semin Colon Rectal Surg 1994;5:193–8.

    Google Scholar 

  34. Alexander-Williams J. The technique of intestinal strictureplasty. Int J Colorectal Dis 1986;1:54–7.

    PubMed  Google Scholar 

  35. Lock MR, Fazio VW, Farmer RG, Jagelman DG, Lavery IC, Weakley FL. Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel. Ann Surg 1981;194:754–60.

    PubMed  Google Scholar 

  36. Craft CF, Mendelson G, Cooper HS, Yardley JH. Colonic “precancer” in Crohn's disease. Gastroenterology 1981;80:578–84.

    PubMed  Google Scholar 

  37. Simpson S, Traube J, Riddell RH. The histologic appearance of dysplasia (precarcinomatous change) in Crohn's disease of the small bowel and large intestine. Gastroenterology 1981;81:492–501.

    PubMed  Google Scholar 

  38. Richards ME, Rickert RR, Nance FC. Crohn's disease associated carcinoma: a poorly recognized complication of inflammatory bowel disease. Ann Surg 1989;209:764–73.

    PubMed  Google Scholar 

  39. Cuvelier C, Bekaert E, De Potter C, Pauwels C, De Vos M, Roels H. Crohn's disease with adenocarcinoma and dysplasia: macroscopical, histological, and immunohistochemical aspects of two cases. Am J Surg Pathol 1989;13:187–96.

    PubMed  Google Scholar 

  40. Cooper DJ, Weinstein MA, Korelitz BI. Complications of Crohn's disease predisposing to dysplasia and cancer of the intestinal tract: considerations of a surveillance program. J Clin Gastroenterol 1984;6:217–24.

    PubMed  Google Scholar 

  41. Senay E, Sachar DB, Keohane M, Greenstein AJ. Small bowel carcinoma in Crohn's disease: distinguishing features and risk factors. Cancer 1989;63:360–3.

    PubMed  Google Scholar 

  42. Bachwich DR, Lichtenstein GR, Traber PG. Cancer in inflammatory bowel disease. Med Clin North Am 1994;78:1399–412.

    PubMed  Google Scholar 

  43. Kerber GW, Frank PH. Carcinoma of the small intestine and colon as a complication of Crohn disease: radiologic manifestation. Radiology 1984;150:639–45.

    PubMed  Google Scholar 

  44. Adler SN, Lyon DT, Sullivan PD. Adenocarcinoma of the small bowel; clinical features, similarity to regional enteritis, and analysis of 338 documented cases. Am J Gastroenterol 1982;77:326–30.

    PubMed  Google Scholar 

  45. Kelly IM, Bartram CI. Pseudotumoral appearance of small bowel strictureplasty for Crohn's disease. Abdom Imaging 1993;18:366–8.

    PubMed  Google Scholar 

  46. Milman PJ, Gold BM, Bagla S, Thorn R. Primary ileal adenocarcinoma simulating Crohn's disease. Gastrointest Radiol 1980;5:55–8.

    PubMed  Google Scholar 

  47. Fresko D, Lazarus SS, Dotan J, Reingold M. Early presentation of carcinoma of the small bowel in Crohn's disease (Crohn's carcinoma): case reports and review of the literature. Gastroenterology 1982;82:783–9.

    PubMed  Google Scholar 

  48. Korelitz BI. Carcinoma of the intestinal tract in Crohn's disease: results of a survey conducted by the National Foundation for Ileitis and Colitis. Am J Surg 1983;78:44–6.

    Google Scholar 

  49. Collier PE, Turowski P, Diamond DL. Small intestinal adenocarcinoma complicating regional enteritis. Cancer 1985;55:516–21.

    PubMed  Google Scholar 

  50. Swinson CM, Slavin G, Coles EC, Booth CC. Coeliac disease and malignancy. Lancet 1983;1:111–5.

    PubMed  Google Scholar 

  51. Holmes GK, Dunn GI, Cockel R, Brookes VS. Adenocarcinoma of the upper small bowel complicating coeliac disease. Gut 1980;21:1010–6.

    PubMed  Google Scholar 

  52. Holmes GK, Prior P, Lane MR, Pope D, Allan RN. Malignancy in coeliac disease—effect of a gluten free diet. Gut 1989;30:333–8.

    PubMed  Google Scholar 

  53. Kendall GP, Hawley PR, Nicholls RJ, Lennard-Jones JE. Strictureplasty: a good operation for small bowel Crohn's disease? Dis Colon Rectum 1986;29:312–6.

    PubMed  Google Scholar 

  54. Whelan PJ, Saibil FG, Harrison AW. New options in the surgical management of Crohn's disease. Can J Surg 1987;30:133–6.

    PubMed  Google Scholar 

  55. Gaetini A, De Simone M, Resegotti A. Our experience with strictureplasty in the surgical management of Crohn's disease. Hepatogastroenterology 1989;36:511–5.

    PubMed  Google Scholar 

  56. Deutsch AA, Tiquva P, Stern HS. Stapler strictureplasty for Crohn's disease. Surg Gynecol Obstet 1989;169:458–60.

    PubMed  Google Scholar 

  57. Silverman RE, McLeod RS, Cohen Z. Strictureplasty in Crohn's disease. Can J Surg 1989;32:19–22.

    PubMed  Google Scholar 

  58. Dehn TC, Kettlewell MG, Mortensen NJ, Lee EC, Jewell DP. Ten-year experience of strictureplasty for obstructive Crohn's disease. Br J Surg 1989;76:339–41.

    PubMed  Google Scholar 

  59. Pritchard TJ, Schoetz DJ, Caushaj FP,et al. Strictureplasty of the small bowel in patients with Crohn's disease: an effective surgical option. Arch Surg 1990;125:715–7.

    PubMed  Google Scholar 

  60. Keighley MR. Stapled strictureplasty for Crohn's disease. Dis Colon Rectum 1991;34:945–7.

    PubMed  Google Scholar 

  61. Spencer MP, Nelson H, Wolff BG, Dozois RR. Strictureplasty for obstructive Crohn's disease: the Mayo experience. Mayo Clin Proc 1994;69:33–6.

    PubMed  Google Scholar 

  62. Quandalle P, Gambiez L, Colombel JF, Paris JC, Cortot A. Long term follow up of strictureplasty in Crohn's disease. Acta Gastroenterol Belg 1994;57:314–9.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

    Floriano Marchetti M.D., Victor W. Fazio M.B., F.R.A.C.S. & Gokhan Ozuner M.D.

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  1. Floriano Marchetti M.D.
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  2. Victor W. Fazio M.B., F.R.A.C.S.
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  3. Gokhan Ozuner M.D.
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Marchetti, F., Fazio, V.W. & Ozuner, G. Adenocarcinoma arising from a strictureplasty site in Crohn's disease. Dis Colon Rectum 39, 1315–1321 (1996). https://doi.org/10.1007/BF02055130

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