Successful Local Excision of Ileostomy Adenocarcinoma After Colectomy for Familial Adenomatous Polyposis: Report of a Case

Abstract

Primary adenocarcinoma rarely develops at the site of an ileostomy performed for ulcerative colitis (UC), familial adenomatous polyposis (FAP), or Crohn's disease. We describe a case of ileostomy cancer found 14 years after proctocolectomy for FAP with cancer of both the sigmoid colon and rectum. Resection of the ileal mucosa around the stoma was performed three times. To our knowledge, only 35 other such cases have ever been reported. Our review of these cases indicates that routine examination of the stoma by a physician, or even by the patient, may lead to earlier detection of this rare complication, and a better chance of cure through minimal surgery.

Rectal and Pouch Recurrences After Surgical Treatment for Familial Adenomatous Polyposis

“…A revision of this rare complication estimates less than 40 cases of cancer at that site after proctocolectomy. 53,54 Thus, the cancer recurrence risks during follow-up show that FAP is a complex disease with multiple variations that do not fit into one management scheme. This wide clinical variability is generated by the genetic load that may impact oncological outcome and the choice of surgery.…”

Primary Mucinous Adenocarcinoma in an Ileostomy with Adjacent Skin Invasion: A Late Complication of Surgery for Ulcerative Colitis

“…A handful of cases have been reported following similar procedures performed for familial adenomatous polyposis [10,11,14]. Hence, some authors suggest that the regenerative epithelial hyperproliferation brought about by chronic irritation at the mucocutaneous junction appears to be a factor in the unclear aetiology of the growth as well as trauma and/or chemical agents, such as those used as stomal adhesives [6,9,[14][15][16][17][18]. Also, changes in the bacterial flora have been associated with the occurrence of neoplasia [19].…”

Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

“…The mechanism of cancers arising at ileostomy sites is also speculative. Most grow at the mucocutaneous junction [ 17 ]. Previous reports have proposed that physical trauma or chemical or physical irritation predisposes the ileal mucosa to colonic metaplasia, dysplasia, and malignant change.…”