A Case of Lymph Node Metastasis in Fossa Ischiorectalis from Early Low Rectal Cancer

Masaaki Takeuchi, Yoshito Akagi, Tetsushi Kinugasa, Nobuya Ishibashi and Kazuo Shirouzu

Department of Surgery, Kurume University

We report a very rare case of lymph node metastasis in fossa ischiorectalis from early low rectal cancer. A 47-year-old man undergoing local transanal resection for a 5 cm IIa congregational lesion of the lower rectum, in March 2008 was pathologically diagnosed with well-differentiated adenocarcinoma, ly0, v0, depth 1,500 μm, and recommended for curative surgery. No lymph nodes appeared swollen in preoperative enhanced computed tomography (CT) and preoperative calcinoembryonic antigen (CEA) was 5.3 ng/ml. We underwent internal sphincteric resection (ISR), upper D3 dissection and covering ileostomy, in May 2007. Histologically, partial external sphincteric resection (ESR) was done and one lymph node metastasis of the fossa ischiorectalis was seen. The ileostoma was closed in October 2007 and CEA was normalized and has been maintained in the normal range during the one year since curative surgery.

Key words
early low rectal cancer, lymph node metastasis of fossa ischiorectalis, Internal sphincteric resection (ISR)

Reprint requests
Masaaki Takeuchi Department of Surgery, Kurume University
67 Asahimachi, Kurume, 830-0011 JAPAN

Accepted
May 27, 2009

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