Rectal Adenocarcinoma in Crohnʼs Disease: A Case Report

Abstract

This is a case of a 21 year old male patient who underwent total colectomy and a colostomy for a long standing and extensive Crohns disease who developed rectal adenocarcinoma and eventually expired. In Crohn's disease, cancer risk data is limited. If colorectal cancer does develop, however, the prognosis is recognized to be poor with reduced survival.This 21 year old male presented to our clinic in 2007 at age 13 who was diagnosed with Crohn disease at age 7.His medical history is remarkable with 4 to 5 blood transfusions for anemia, growth hormone deficiency, hypogonadism, vitamin D deficiency and a stable pituitary microadenoma. He was managed with numerous courses of steroids, antimetabolites such as infliximab, certolizumab and 5ASA.His Colonoscopy in 2008 revealed complete loss of vascularity and large pseudo polyps, biopsy was consistent with markedly active chronic colitis with crypt distortion in the colon, marked acute ileitis and acute chronic inflammation in the stomach supporting the diagnosis of Crohn disease .Despite aggressive medical management, his symptoms continued to progress and was hesitant to have an ileostomy over the years .In august 2014 he has failed all medications and was placed on Entyvio.He was having flare ups and recurrent pelvic and abdominal abscess with partial bowel obstruction, perforation of the ileum likely contributed to the abscess and impending fistula. His routine colonoscopy procedure was not successful as there was a large rectal mass which was consistent with malignancy and the biopsy of the rectal mass showed a poorly differentiated infiltrating adenocarcinoma .So, he had diagnostic laparoscopy converted to exploratory laparotomy, extensive lysis of abdomen and pelvic adhesions, drainage of pelvic and abdominal abscesses, ileocectomy and colostomy, eventually deteriorated and expired with rectal adenocarcinoma.Colorectal cancer represents the major cause for excess morbidity and mortality by malignant disease in ulcerative colitis as well as in Crohn's disease. Younger patients with long-standing Crohn's disease should be considered for colonic surveillance to permit earlier diagnosis and treatment of potential colorectal carcinoma. Cancer risk begins to be significant 8 years after the onset of pancolitis (involvement of entire large intestine), or 12-15 years after the onset of left-sided colitis. Colonoscopy every 1 to 2 years with biopsies for dysplasia.3062_A Figure 1. a large rectal mass3062_B Figure 2. Showing large pseudopolyps