Abstract
Patients treated with restorative proctocolectomy for ulcerative colitis occasionally develop neoplasia from the rectal mucosal remnants. We report a case of a 65-year-old male who developed an adenocarcinoma from the rectal stump after a double-stapled ileorectal J-pouch for ulcerative colitis. We emphasize the need to perform the anastomosis either at the level of the dentate line or just cephalad to the anal transitional zone. Furthermore, when high-grade dysplasia at the rectum is evident, either an ileal pouch-anal anastomosis with mucosectomy or completion proctectomy with an end Brooke ileostomy should be offered. This is the second report in the literature of a carcinoma arising after use of the double-stapled ileal pouch-anal anastomotic technique.
Similar content being viewed by others
References
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978;2:85–8.
Heald RJ, Allen DR. Stapled ileoanal anastomosis: a technique to avoid mucosal proctectomy in the ileal pouch operation. Br J Surg 1986;73:571–2.
Lavery IC, Tuckson WB, Easley KA. Internal anal sphincter function after total abdominal colectomy and stapled ileal pouch-anal anastomosis without mucosal proctectomy. Dis Colon Rectum 1989;32:950–3.
Ziv Y, Fazio VW, Sirimarco MT, Lavery IC, Goldblum JR, Petras RE. Incidence, risk factors and treatment of dysplasia in the anal transitional zone after ileal pouch-anal anastomosis. Dis Colon Rectum 1994;37:1281–5.
Slors JF, Ponson AE, Taat CW, Bosma A. Risk of residual rectal mucosa after proctocolectomy and ileal pouch anal reconstruction with the double-stapling technique: postoperative endoscopic follow-up study. Dis Colon Rectum 1995;38:207–10.
Ravith MM. The reception of new operation. Ann Surg 1984;200:231–46.
Puthu D, Rajan N, Rao R, Rao L, Venugopal P. Carcinoma of the rectal pouch following restorative proctocolectomy: report of a case. Dis Colon Rectum 1992;35:257–60.
Stern H, Walfisch S, Mullen B, McLeod R, Cohen Z. Cancer in an ileoanal reservoir: a new late complication? Gut 1990;31:473–5.
Rodriguez-Sanjuan JC, Polavieja MG, Naranjo A, Castillo J. Adenocarcinoma in an ileal pouch for ulcerative colitis. Dis Colon Rectum 1995;38:779–80.
Sequens R. Cancer in the anal canal (transitional zone) after restorative proctocolectomy with stapled ileal pouch-anal anastomosis. Int J Colorectal Dis 1997;12:254–5.
Johnson WR, McDermott FT, Hughes ES, Pihl EA, Milne BJ, Price AB. The risk of rectal carcinoma following colectomy in ulcerative colitis. Dis Colon Rectum 1983;26:44–6.
Grundfest SF, Fazio V, Weiss RA,et al. The risk of cancer following colectomy and ileorectal anastomosis for extensive mucosal ulcerative colitis. Ann Surg 1981;193:9–14.
Morson BC. The large intestine. In: Saint W, Symens C, eds. Systemic pathology. London: Churchill Livingstone, 1978:1117–26.
Johnson WR, McDermott FT, Hughes ES. Mucosal dysplasia: a major predictor of cancer following ileorectal anastomosis. Dis Colon Rectum 1983;26:697–700.
O'Connell PR, Pemberton JH, Weiland LH,et al. Does rectal mucosa regenerate after ileoanal anastomosis? Dis Colon Rectum 1987;30:1–5.
Heppell J, Weiland LH, Perrault J, Pemberton JH, Telander L, Beart RW Jr. Fate of rectal mucosa after rectal mucosectomy and ileoanal anastomosis. Dis Colon Rectum 1983;26:768–71.
Watson LC, Friedman HI, Griffin DC, Norton LW, Mellick PW. Small bowel neomucosa. J Surg Res 1980;28:280–91.
Hamptom JM. Rectal mucosal stripping: a technique for preservation of the rectum after total colectomy for chronic ulcerative colitis. Dis Colon Rectum 1976;19:133–5.
Santos MC, Thompson JS. Late complications of the ileal pouch-anal anastomosis. Am J Gastroenterol 1993;88:3–10.
Lofberg R, Liljeqvist L, Lindquist K, Veress B, Reinholt FP, Tribukait B. Dysplasia and DNA aneuploidy in a pelvic pouch: report of a case. Dis Colon Rectum 1991;34:280–3.
De Silva HJ, Millard PR, Kettewell M. Mucosal characteristics of pelvic ileal pouch. Gut 1990;32:61–5.
Vieth M, Grunewald M, Niemeyer C, Stolte M. Adenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative colitis. Virchows Arch 1998;433:281–4.
Author information
Authors and Affiliations
Additional information
Supported in part by a research grant from the David G. Jagelman Research Fund.
About this article
Cite this article
Rotholtz, N.A., Pikarsky, A.J., Singh, J.J. et al. Adenocarcinoma arising from along the rectal stump after double-stapled ileorectal J-pouch in a patient with ulcerative colitis: The need to perform a distal anastomosis. Dis Colon Rectum 44, 1214–1217 (2001). https://doi.org/10.1007/BF02234647
Issue Date:
DOI: https://doi.org/10.1007/BF02234647