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Carcinoma of sigmoid colon following urinary diversion: a case report and review of literature.

Khan MN, Naqvi AH, Lee RE - World J Surg Oncol (2004)

Bottom Line: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented.At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon.Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case.

View Article: PubMed Central - HTML - PubMed

Affiliation: General Surgery, L & D Hospital, Lewsey Road, Luton, UK. MKHAN702@AOL.COM

ABSTRACT

Background: The association of ureterosigmoidostomy with colonic cancer is well established. A 100-fold increased risk of malignancy has been proposed in association with ureterosigmoidostomy. Characteristically there is a latent period of around 20-30 years before the occurrence of cancer.

Case presentation: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented. The patient underwent three operations in his infancy for exstrophy but after failure to close bladder, ureterosigmoidostomy was attempted at the age of 5 years and was converted to an ileal conduit after 8 months. At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon.

Conclusion: Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case.

No MeSH data available.


Related in: MedlinePlus

Gross view of the resected specimen. Inset – the same specimen opened longitudinally to display the tumor.
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Related In: Results  -  Collection


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Figure 1: Gross view of the resected specimen. Inset – the same specimen opened longitudinally to display the tumor.

Mentions: On examination he was apyrexial, hemodynamically stable but looked pale. Long midline and para-median scars were visible and abdomen was slightly distended. Urostomy bag was present in the right iliac fossa. He had minimal tenderness in the left half of the abdomen. Bowel sounds were audible and digital examination of the rectum was unremarkable. Routine blood tests showed mildly deranged renal functions (urea of 9.2 mmol/L and creatinine of 139 mmol/L). Plain abdominal x-ray showed faecal loading of the left colon. A couple of enemas were prescribed but they failed to relieve the symptoms. Over the next two days he gradually deteriorated with increasing abdominal distension and vomiting. Repeat abdominal film showed dilated small and large bowel loops. An unprepared gastrograffin enema was organized which showed a stricture at the recto-sigmoid junction. An emergency laparotomy was carried out which revealed an annular stenosing lesion at the recto-sigmoid junction with enlarged mesenteric lymph nodes and dilated proximal bowel. A loop of ileum was adherent to the surface of colon at the site of tumor. A Hartman's procedure was carried out and the adherent loop of ileum was also excised (figure 1). Histopathology showed it to be Dukes C, poorly differentiated adenocarcinoma of the sigmoid colon. Proximity of the tumor to the ectopic urothelium in the sigmoid colon was also demonstrated, which was the site of previous ureterosigmoidostomy. Further staging investigations did not show any evidence of metastasis. The Hartman's procedure was reversed 2 months later and currently he is receiving chemotherapy.


Carcinoma of sigmoid colon following urinary diversion: a case report and review of literature.

Khan MN, Naqvi AH, Lee RE - World J Surg Oncol (2004)

Gross view of the resected specimen. Inset – the same specimen opened longitudinally to display the tumor.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC425598&req=5

Figure 1: Gross view of the resected specimen. Inset – the same specimen opened longitudinally to display the tumor.
Mentions: On examination he was apyrexial, hemodynamically stable but looked pale. Long midline and para-median scars were visible and abdomen was slightly distended. Urostomy bag was present in the right iliac fossa. He had minimal tenderness in the left half of the abdomen. Bowel sounds were audible and digital examination of the rectum was unremarkable. Routine blood tests showed mildly deranged renal functions (urea of 9.2 mmol/L and creatinine of 139 mmol/L). Plain abdominal x-ray showed faecal loading of the left colon. A couple of enemas were prescribed but they failed to relieve the symptoms. Over the next two days he gradually deteriorated with increasing abdominal distension and vomiting. Repeat abdominal film showed dilated small and large bowel loops. An unprepared gastrograffin enema was organized which showed a stricture at the recto-sigmoid junction. An emergency laparotomy was carried out which revealed an annular stenosing lesion at the recto-sigmoid junction with enlarged mesenteric lymph nodes and dilated proximal bowel. A loop of ileum was adherent to the surface of colon at the site of tumor. A Hartman's procedure was carried out and the adherent loop of ileum was also excised (figure 1). Histopathology showed it to be Dukes C, poorly differentiated adenocarcinoma of the sigmoid colon. Proximity of the tumor to the ectopic urothelium in the sigmoid colon was also demonstrated, which was the site of previous ureterosigmoidostomy. Further staging investigations did not show any evidence of metastasis. The Hartman's procedure was reversed 2 months later and currently he is receiving chemotherapy.

Bottom Line: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented.At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon.Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case.

View Article: PubMed Central - HTML - PubMed

Affiliation: General Surgery, L & D Hospital, Lewsey Road, Luton, UK. MKHAN702@AOL.COM

ABSTRACT

Background: The association of ureterosigmoidostomy with colonic cancer is well established. A 100-fold increased risk of malignancy has been proposed in association with ureterosigmoidostomy. Characteristically there is a latent period of around 20-30 years before the occurrence of cancer.

Case presentation: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented. The patient underwent three operations in his infancy for exstrophy but after failure to close bladder, ureterosigmoidostomy was attempted at the age of 5 years and was converted to an ileal conduit after 8 months. At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon.

Conclusion: Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case.

No MeSH data available.


Related in: MedlinePlus