Case 3: A 29-year-old man first developed diarrhea in 1983 and, after barium radiographs in Victoria, British Columbia, Crohn’s disease of the colon was diagnosed. He was treated with sulphasalazine and corticosteroid enemas. Symptoms initially resolved but then promptly recurred with weight loss. Colonoscopy confirmed the presence of extensive and deep ulcerations with rectal and cecal sparing; colonic biopsies showed inflammatory changes but no granulomas or dysplasia. Results of ileal biopsies were normal. He was treated with parenteral nutrition and intravenous corticosteroids. In April 1987, he declined surgical treatment, and a course of prednisone was completed by June 1987. He was referred for a second opinion in 1987; surgical treatment was again declined. He was followed-up elsewhere, where he was administered repeated blood transfusions for anemia. In December 1990, he developed an acute abdomen while playing football. Laparotomy showed a perforated rectosigmoid carcinoma with generalized peritonitis; biopsies confirmed the presence of a poorly differentiated adenocarcinoma involving the liver, with multiple nodules. Extensive bilateral bronchopneumonia developed, followed by death, and an autopsy confirmed the presence of advanced colorectal cancer with extensive hepatic metas-tases.
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Case 4: A 48-year-old man was diagnosed with rectal stump cancer in 1985. He had a subtotal colectomy for presumed ulcerative colitis in 1967. Later in the same year, he developed a peristomal abscess with a fistula to the ileum requiring terminal ileum resection and repositioning of his ileostomy; the resected ileum showed granulomatous inflammation, consistent with Crohn’s disease. In 1985, purulent rectal stump drainage was first observed, leading to rectal stump excision; a well differentiated rectal carcinoma was present. No lymph nodes were involved, but local involvement of the proximal muscle margin was detected. Following the rectal stump excision, he had pelvic radiation. His perineal wound healed poorly with persistent drainage. Treatment with metronidazole 1000 mg daily had no definite effect on the drainage. He was referred to the University of British Columbia in 1987 because of a chronic deep perineal wound and scrotal fistula; the wound was debrided and the fistula excised. From July 1987 to December 1987, he had repeated surgical debridements with excision of the perineal skin. By July 1988, the perineal skin had completely healed.