A Case of Metastatic Carcinoma at an Anal Fistula

Katsuji Tokuhara, Hideharu Yamanaka, Daisuke Ito, Takatomo Koshiba, Masahito Sato and Masafumi Kogire

Department of Surgery, Kishiwada City Hospital

Since 1995, a 69-year-old man had noted pus discharge and bleeding from the perianal region, where a soybeen sized tumor appeared in May 1999. He was admitted to our hospital in May 2000 because the perianal tumor enlarged gradually and bleeding and pus discharge from the tumor became frequent. Biopsy of the ulcerated 38×27mm tumor showed moderately differentiated adenocarcinoma. Colonoscopy revealed an ulcerated tumor 20cm from the anus. Biopsy showed moderately differentiated adenocarcinoma. Because the histologic features of the perianal tumor closely resembled those of the sigmoid colon tumor, we considered exfoliate cells from the sigmoid colon carcinoma had implanted and made the metastatic tumor in an anal fistula. The patient underwent abdominosacral excision of the sigmoid colon and rectum with an uneventful postoperative course. Anal fistula is common, but our case emphasizes that the whole colon should be examined if carcinoma is found in an anal fistula. Anal fistula in a patient who has been operated on for colon cancer should be closely checked at follow-up.

Key words
colon cancer, fistula cancer, anal fistula

Reprint requests
Katsuji Tokuhara Department of Surgery Kishiwada City Hospital 2 Gakuhara-cho, Kishiwada, 596-8501 JAPAN

Accepted
June 26, 2001

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