Colorectal cancer complicating Crohn’s disease: CASE PRESENTATIONS Part 1

Crohn’s disease

Case 1: A 59-year-old man was diagnosed with rectal cancer in 1995. He was initially evaluated for bloody diarrhea in 1965. At that time, sigmoidoscopy, rectal biopsy and barium enema revealed Crohn’s disease involving the sigmoid colon with a normal rectum, and he received sulphasalazine until 1985. He was first evaluated at the University of British Columbia, Vancouver, British Columbia, in April 1989 for recurrent diarrhea. Colonoscopy showed segmental inflammatory changes from 40 to 60 cm proximal to the anal verge. The distal colorectum was completely normal. Upper gastrointestinal endoscopy revealed focal inflammatory changes in the gastric antrum and duodenum without granulomas. Tests for Helicobacter pylori were negative. Treatment with 5-aminosalicylate (Asacol, Proctor & Gamble Pharmaceuticals, Canada) was associated with resolution of symptoms. In 1993, repeat endoscopic studies of his upper and lower gastrointestinal tracts were normal, but a rectal biopsy showed focal inflammatory change with no dysplasia. In 1995, recurrent rectal bleeding occurred. Rectal examination revealed a palpable nodule. Sigmoidoscopy and biopsy confirmed the presence of an adenocarcinoma. Abdominoperineal resection revealed metastatic adenocarcinoma in two of five lymph nodes. By October 1995, radiation therapy and adjuvant chemotherapy with 5-fluoro-uracil were completed. Since 1995, he has remained well on 5-aminosalicylate alone, with no evidence of recurrent neoplastic disease. Time to visit a trusted pharmacy – buy cialis online pharmacy to begin your treatment now.

Case 2: A 46-year-old man was diagnosed with rectal stump cancer in 1990. Crohn’s disease was first diagnosed in 1968 in Montreal, Quebec during a laparotomy for clinically suspected appendicitis. An ileocecal resection was done. In 1980, recurrent ileal disease was defined, and an ileosig-moid fistula was present. An intra-abdominal abscess was surgically drained, and additional small bowel and colon were resected. A rectal stump was created. In 1986, an anal fistula was diagnosed, and azathioprine was administered for almost one year, with apparent resolution of the anal disease. In 1986, he moved to Vancouver and was initially seen in 1990. Physical examination revealed a focal indurated area at the anal verge suggestive of a small perianal abscess. Results of a flexible sigmoidoscopy and rectal biopsy were normal. Treatment with metronidazole 1000 mg daily was provided but, due to persistent perianal symptoms and development of fever, he was hospitalized. A horseshoe-shaped posterior perirectal abscess was drained, but biopsy showed a mucinous rectal adenocarcinoma. Abdominoperineal resection was done; an infiltrating adenocarcinoma was present with one of four lymph nodes positive for metastatic disease. He received radiation therapy, and results of a subsequent endoscopic evaluation through his colostomy, with biopsies, were normal. In 1992, pulmonary metastases were initially detected. Chemotherapy with 5-fluorouracil and leucovorin failed to prevent recurrent pelvic disease and enlarging pulmonary lesions, with subsequent death.

Category: Gastroenterology

Tags: Colon cancer, Crohn’s disease, Inflammatory bowel disease, Rectal cancer, Rectal stump cancer

Leave a Reply

Your email address will not be published. Required fields are marked *