Development of two cancers in the same patient after ileorectal and ileal pouch anal anastomosis for familial adenomatous polyposis.

OBJECTIVE: To report a case of a patient with familial adenomatous polyposis. CLINICAL PRESENTATION AND INTERVENTION: A 36-year-old male patient who suffered from rectal bleeding was treated with colectomy and ileorectal anastomosis for familial adenomatous polyposis (FAP) in 1974. After 19 years, in situ adenocarcinoma was detected in the rectal stump. Completion proctectomy, mucosectomy, and hand-sewn ileal pouch anal anastomosis with protective ileostomy were performed. In 2002, a metachronous cancer was detected at the anastomosis and abdominoperineal resection of the pouch and end ileostomy were performed. Later on, the perineum was excised locally because of cancer recurrence.
CONCLUSION: This case shows that lifetime surveillance of the FAP patients after surgery is crucial.