Recurrence of colonic cancer twice at the site of stapled colorectal anastomosis.

Recurrence at the site of a stapled anastomosis is generally believed to result from the luminal implantation of viable cancer cells during stapling. We report a case in which colon cancer recurred twice at the site of a stapled anastomosis, despite povidone iodine (PVP-I) lavage consisting of an enema with 5% PVP-I solution before the operation and intraoperative lavage of the rectal remnant and the descending colon with a 10% PVP-I solution. Three months after sigmoidectomy to resect a carcinoma of the sigmoid colon, a circular anastomotic recurrence was found at the suture line after anastomosis with a stapler. However, 11 months after the subsequent resection and reanastomosis to remove the first anastomotic recurrence, another anastomotic recurrence was found. We performed abdominoperineal resection for the second recurrence at the site of the stapled anastomosis. Suture-line recurrence could not be prevented in the present case despite lavage with a PVP-I solution for prophylaxis.

Resection of asynchronous quadruple advanced colonic carcinomas followed by reconstruction with ileal interposition between the transverse colon and rectum.

We report an extremely rare case of resectable asynchronous quadruple advanced colonic carcinomas. Successful reconstruction was performed after resection with an ileal interposition between the remaining colon and rectum, and the patient recovered bowel function. Resections of the four colonic lesions in three operations allowed us to leave a portion of the large bowel and to thereby preserve the rectum and a portion of the transverse colon. After resection of the third and fourth cancer lesions, we reconstructed the large bowel with ileal segment interposition between the residual transverse colon and rectum, leaving a 15-cm-long segment portion of the transverse colon. This surgical procedure is an option for reconstruction after left-sided colectomy.

Chronic anisakiasis of the ascending colon associated with carcinoma.

Chronic anisakiasis of the colon is rare and difficult to diagnose. We report a case of chronic anisakiasis associated with advanced colonic carcinoma. A 69-year-old man was admitted for abdominal pain, diarrhea, and urticaria. Right hemicolectomy was performed because of an obstruction of the ascending colon and a palpable tumor of the right lower abdomen. The lesion was thought to be located in the deeper layers of the ascending colon. Preoperative examinations failed to detect the coexistence of anisakiasis and carcinoma of the colon. The anisakis was identified morphologically in the intestinal wall of the resected specimen and by an elevated titer of an IgE antibody specific to the parasite. Seventy-five cases of colonic and rectal anisakiasis, including the present case, have been reported in Japan. This is the only reported case of anisakiasis to appear in association with colonic carcinoma.

Colonic adenocarcinoma metastatic to the thyroid: report of a case.

We report herein the case of a 67-year-old man who was admitted to our hospital with a 3-month history of hoarseness, a cervical mass, and weak muscles of the extremities 6 years after undergoing a right colectomy for carcinoma. Physical and imaging examinations disclosed a nodule in the thyroid with swollen cervical lymph nodes, multiple pulmonary lesions with pleural effusion, and a cerebral mass. Fine-needle aspiration cytology of the thyroid nodule and brush cytology of the lung mass revealed adenocarcinoma, which was consistent with a diagnosis of metastases from the primary colon adenocarcinoma to the thyroid, brain, and lung. The patient eventually died from the malignancy, although he survived for 4 months after the disclosure of the metastases. The rarity, diagnosis, and prognosis of thyroid metastasis from colon carcinoma are discussed.