Dear Editor, Angiosarcomas are a subgroup of sarcomas and represent only 1% of this tumor entity. Its clinical manifestation is mostly dependent from their side of origin. A manifestation in the abdominal cavity and especially in the peritoneum is an extreme rarity being reported so far only occasionally. In this correlation, chronic inflammation or radiation are discussed as causal. Different and multimodal therapeutic options are proposed but the prognosis of these tumors is poor and no standard therapy exists. In this case, a 75-year-old female was admitted to our clinic with symptoms of complete bowel obstruction. Patient’s history showed a squamous cell carcinoma of the anus 5 years before. Initial staging revealed a T2 tumor of 4 cm in diameter with uncertain infiltration of local lymph nodes but no distant metastases. A primary radiochemotherapy was performed. Radiation included a local application of 55.8 Gy and an intrapelvic radiation of the draining lymph nodes with 45 Gy. The chemotherapy contained two cycles of leucovorin and 1,000 mg 5FU per square meter body surface. A complete remission of the anal carcinoma was observed with this therapy. Regular follow-up did not show any progression or recurrence of the disease. Due to radiation, an anal eczema was observed with consecutive symptoms like itching, weeping, and partial fecal incontinence, so that 45 months after primary therapy a perineal amputation of the rectum with a colostoma was performed. Furthermore, the patient had a stroke with hemiparesis and complete guardianship 3 months later. Five months later, the patient was admitted with complete bowel obstruction and pneumonia. At this point, the patient presented in a reduced general condition of health and cachexia (40-kg body weight, height 165 cm) and an ileus. Immediate laparotomy showed a conglomerate tumor of small bowel in the lower right abdomen resulting in complete bowel obstruction. Complete adhesiolysis was performed and 1,000-ml interenteric blood was mobilized without a source of an active bleeding. The small bowel appeared partially ischemic, requiring an ileocecal resection and segmental resection of the ileum. The postoperative course was complicated with occurring sepsis. A relaparotomy 10 days later showed a lower abdominal peritonitis due to a leakage of both anastomoses and again a massive ischemic condition of the small bowel and the greater omentum. After resection a Hartmann’s procedure was performed with a terminal ileostomy. In the following days, the patient developed a full renal failure and died 5 days later in a septic multiorgan failure. A postmortem autopsy was denied by the relatives. Histopathologic results of the resected specimen showed directly below the peritoneum in the subserosa of the ileum, cecum, and ascending colon spindle-cell-like configurated atypic tumor proliferations with erythrocytes in the lumina. The lining cells were with an epithelioid appearance with big vesicular cores and prominent nucleolus. Atypical vascular proliferations were infiltrating the muscularis propria and could be seen locally directly under the submucosal layer. Immunohistochemically, there was a strong positivity of the tumor cells for endothelial markers CD31 and factor XIII and a weak positivity for CD34. Int J Colorectal Dis (2009) 24:465–466 DOI 10.1007/s00384-008-0563-4