Synchronous mucinous adenocarcinoma of the recto sigmoid revealed by and seeding an anal fistula. (A case report and review of the literature).

INTRODUCTION: There are few cases of synchronous rectal adenocarcinoma revealed by an anal fistula. The diagnosis of synchronous mucinous adenocarcinoma of the recto sigmoid and anal canal remains difficult. The chronic anal fistula can be mistaken as the common manifestation of a benign perianal abscess or fistula. CASE PRESENTATION: We present a rare case of a Greek Caucasian 79year old male patient with anal fistula and a recurrent perianal abscess who subsequently was found to have developed synchronous rectosigmoid and perianal mucinous adenocarcinoma on biopsy. The histological exam revealed mucinous adenocarcinoma in two sites, representing two tumors, cells were immunopositive for cytokeratin 20 and negative in cytokeratin 7. The patient underwent "laparoscopic extralevator abdominoperineal excision " with both lesions being resected. There is no recurrence after four years of follow up. CONCLUSIONS: This case highlights the importance of high suspicion, further investigation and the need of biopsy in all anal fistulae.

Dysfunctional loop ileostomy after low anterior resection for rectal cancer in the presence of Meckel's diverticulum: a case report.

INTRODUCTION: A temporary protective loop ileostomy is a routine procedure to protect the anastomosis in patients who undergo low anterior resection for rectal cancer. The aim of this case report is to present a rare complication caused by Meckel's diverticulum. CASE PRESENTATION: We describe a case of a 71-year-old white man with dysfunctional ileostomy after low anterior resection for rectal cancer due to adhesions and pressing effects of Meckel's diverticulum near the ileostomy site, which led to volvulus of his small intestine and obstruction. As a result he underwent a supplementary operation to resolve this complication by Meckel's diverticulum resection. CONCLUSIONS: During a low anterior resection for rectal cancer and a protective ileostomy procedure the presence of Meckel's diverticulum should not be ignored. Our proposal is the primary resection of Meckel's diverticulum as the best surgical choice; according to the limited international literature on such cases we report a possible alternative to a protective ileostomy by creating a conduit using Meckel's diverticulum as a stoma.