Crohn病に合併した下部直腸肛門管のcolitic cancerに対して肛門温存術を施行した1例

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  • A Case of Lower Colorectal Cancer Associated with Crohn Colitis Treated by Anus-preserving Surgery

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We describe a case of lower colorectal cancer associated with Crohn colitis in which anus-preserving surgery was performed. The patient, a 40-year-old woman, was first given a diagnosis of Crohn disease (CD) in 1978, when a longitudinal ulcer and pseudopolyposis of the large intestine extending from the cecum to the sigmoid colon was discovered, together with stenosis of the ascending colon. She underwent subtotal proctocolectomy in 1988, and thereafter a wait-and-see approach was adopted by internal medicine specialists. However, stenosis developed at the site of anastomosis on several occasions from 2003, and the patient underwent endoscopic dilatation at regular intervals. Because high-grade dysplasia of the remnant rectal mucosa was found in January 2009, she was admitted to our hospital for surgery due to the possibility that cancer might develop. Extirpation of the remnant rectum and ileoanal anastomosis with diverting loop ileostomy was performed. The specimen was diagnosed pathologically as adenocarcinoma (tub1), pSM, N0, pStage I. Because of improvements in medical management, the number of CD patients undergoing long-term treatment has increased. We expect that surveillance will reveal more CD patients with precancerous dysplasia and early stage cancer in the future. Anus-preserving surgery is a realistic option for such patients.

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