ADENOCARCINOMA OF THE ILEUM OCCURRING AT THE SITE OF ILEOSTOMY CLOSURE AFTER ILEAL-ANAL POUCH CREATION FOR ULCERATIVE COLITIS

Case Presentation A 55-year-old female patient with Idiopathic Ulcerative Colitis (IUC) since 1995. After 15 years of disease and clinical intractability, she underwent total proctocolectomy with ileo-anal pouch formation in three stages. In 2023, after multiple medical consultations over a period of 2 months, she was admitted for hospitalization due to hypogastric pain near the surgical scars, where the skin had a rock-like appearance, associated with fever and nausea. An abdominal CT scan revealed a mixed collection located anteriorly to the pelvis. A pouchoscopy and contrast examination of the pouch showed no abnormalities. Percutaneous drainage of the pelvic collection was performed with a Pigtail catheter, initially draining purulent secretion. She then developed intestinal obstruction and underwent exploratory laparotomy, which identified a collection in the abdominal wall, stenosis of the small intestine at the previous ileostomy closure site, fistulized to the abdominal wall, and intense fibrosis. An enterectomy of the previous ileo-ileal anastomosis was performed, with primary anastomosis and resection of the entero-cutaneous fistulous tract. Histopathological examination diagnosed moderately differentiated adenocarcinoma in the ileal segment, with perforation into the visceral peritoneum and fistulous tract, invading connective-adipose tissue and skeletal muscle.

Discussion Among gastrointestinal neoplasms, only 2-3% originate from the small intestine, making them extremely rare. Their diagnosis is often delayed due to nonspecific symptoms, presenting as an acute complication. A Canadian study demonstrated that only 16% of small intestine adenocarcinomas occurred in the ileum. A Swedish study analyzed 142,008 patients with Inflammatory Bowel Disease (IBD) for the prevalence of small intestine tumors. Of these, 59.8% had Ulcerative Colitis (UC), and only 21 patients presented adenocarcinoma of the small intestine associated with UC. Among the UC patients, it was found that extensive disease had a 2.7 times greater risk of small bowel adenocarcinoma. The highest risk was among patients diagnosed with IBD before the age of 40, as in the case of the reported patient.

Conclusion Studies on this subject suffer from biases due to small sample sizes and short follow-up periods. Therefore, case reports are effective for gathering more reliable statistics in the future.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025