A Case of a Large Fistula Cancer Associated with Fecal Fistula

Tetsuya Abe, Kaoru Azekura, Kiyoshi Hiramatsu, Masashi Ueno, Hirotoshi Ohta, Takashi Takahashi, Akio Yanagisawa^*and Yoh Katoh^*

Department of Surgery and Department of Pathology^*, Cancer Institute Hospital

A 68-year-old man was admitted to our hospital complaining of a large abdominal mass. A firm irregular mass measuring 200×120 mm was palpated around the opening of a fecal fistula. Barium enema revealed stenosis of the sigmoid colon due to extramural compression. Abdominal computed tomography showed a heterogeneous mass containing air. Abdominal magnetic resonance imaging revealed that the rectum and the bilateral common iliac artery and vein were not involved by the tumor. A biopsy specimen revealed well-differentiated adenocarcinoma. Finally the tumor was diagnosed as a large fistula cancer associated with a fecal fistula. Hartmann's operation with wide concomitant resection of the abdominal wall and pubic bone was performed. The large defect of the abdominal wall was repaired with bilateral tensor fascia lata myocutaneous flaps. Macroscopically the huge resected specimen had grown around the fistula which communicated with the sigmoid colon. Histological diagnosis was adenocarcinoma arising in the fecal fistula, because no primary lesion was found in the sigmoid colon. Cancer originating from a fecal fistula is rare; only three cases including this case have been reported in the literature. The chief complaint was a large abdominal mass in the three patients and curative resection was performed only in our case.

Key words
fistula cancer, fecal fistula

Reprint requests
Tetsuya Abe Department of Surgery, Cancer Institute Hospital 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455 JAPAN

Accepted
May 25, 1999

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