Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn’s disease—a unique case report

Abstract

Background Crohn’s disease (CD) is a chronic inflammatory disorder which leads to anorectal fistulas. In rare cases, patients develop anal squamous cell carcinoma (ASCC) within these lesions. There is limited literature regarding ASCC in patients with CD. Here, we report on a unique case of advanced verrucous carcinoma (VC), a rare variant of squamous cell carcinoma, developing on the grounds of extensive chronic anorectal fistulas in CD. Methods and results A 54-year-old male patient with a 20-year history of CD presented with a large inflammatory tumor at the perineal region with multiple discharging perianal fistulas. Histopathological analysis of the perineal mass revealed a VC. Subsequent surgery with radical tumor resection and terminal colostomy resulted in a large perineal cavity and a partially exposed sacrum. The defect extended to a total of 35 × 25 × 25 cm. Reconstruction was achieved through a two-step approach. A first surgical step established an arteriovenous (AV) loop in the upper thigh. Subsequently, a free latissimus dorsi (LD) myocutaneous flap was harvested and anastomosed with the AV loop, allowing for satisfactory closure of the defect and reconstruction of the perianal and perineal region. Conclusion Radical surgical excision with negative margins is the therapy of choice for VC. This case report demonstrates a curative treatment option with special emphasis on the reconstructive possibilities of a unique case of extended perianal and perineal VC associated with chronic anorectal fistulas in CD.

Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

“…Details of our literature selection are shown in Figure 1 . Seventeen studies met the inclusion criteria and were included in this review [ 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The characteristics of included studies are presented in Table 1 , Table 2 and Table 3 .…”

Zweizeitige mikrochirurgische Weichteilrekonstruktion einer komplexen sakralen Wunde unter Verwendung eines arteriovenösen Loops

“…Im Bestreben, die Operationszeit für den Patientin möglichst kurz zu halten, entschieden wir uns für das zweizeitige Vorgehen. Ein ähnliches therapeutisches Konzept mit primärer AV-Loop-Anlage und zweizeitiger Lappendeckung eines großen Beckendefekts wurde bereits von Wachtel et al beschrieben 8 . Als Transplantat diente hier eine freie Latissimus-dorsi-Lappenplastik.…”

Performing Distance Measurements in Curved Facial Regions: A Comparison between Three-Dimensional Surface Scanning and Ultrasound Imaging

“…1 While some of the defects resulting from such tumor extirpation can be closed by simple, intermediate, or complex repair, a large number result in tissue deficits that require flap reconstruction. [2][3][4][5][6] Flap design depends on a plethora of factors; however, initial surgical planning always needs to ensure proper vascularization and blood supply of the flap. 7 Ultrasound imaging is a commonly used tool to visualize the course of vessels prior to surgery and to facilitate the planning…”