Gastro · Vol. 1, No. 2 · 2015 · pp. 59–60 · e-ISSN 2377-8369

Mucinous Tumour in Ileal Pouch Post Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis for Familial Adenomatous Polyposis

James Wei Tatt Toh, Kasim Rahman, Daniel Kozman

Conjoint lecturer, University of Western Sydney, University of New South Wales, James Ruse Dr, Parramatta NSW 2150, Sydney NSW 2052, Australia; Bankstown Hospital, 68 Eldridge Road, Bankstown NSW 2200, AustraliaAustralia
Bankstown Hospital, 68 Eldridge Road, Bankstown NSW 2200, AustraliaAustralia

DOI: https://doi.org/10.17140/goj-1-109 · Published 2015-04-23 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2015 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

We present a fifty-six years old female having surveillance gastroscopy and colonoscopy ten years after a restorative proctocolectomy and Ileal-pouch anal anastomosis (IPAA). This was performed for Familial Adenomatous Polyposis (FAP). The patient was found to have unusual patchy nodular areas of abnormal mucosa in the ileal pouch and at the level of the anastomosis.

Discussion

identified. While malignancy is rare, risk of pouch adenomas is common and ranged between 6 to 75% Risk factors for development of pouch adenomas include >1000 colonic polyps and ISSN 2377-8369

age >50 years old 5, age of pouch, with pouches >10 years old at high risk of adenoma2 and those who have previously developed pouch adenomas.3

It is unclear why the risk of malignant transformation in these patients is low, but most cohort studies have shown adenomas to be tubular or tubulovillous with only a small percentage demonstrating dysplasia. To the best of our knowledge, there have been no reports of mucinous tumours within an ileal pouch in the literature.

While the incidence of malignancy within an ileal pouch is low, this case illustrates the importance of surveillance for patients who have had restorative proctocolectomy and IPAA for FAP. Apart from ileal pouch malignancy, patients may also develop anastomotic site tumours and anal transitional zone tumours, although this is also a rare entity.6 Older pouches are more at risk of malignancy. In this case, the mucinous tumour was found thirteen years after restorative proctocolectomy and IPAA.

The Australian Clinical Practice Guidelines and European guidelines recommend annual pouch surveillance post restorative proctocolectomy and IPAA for FAP.7,8 As the risk of pouch adenoma and adenocarcinoma, anal transitional zone and anastomotic tumours increases with time, FAP patients post restorative proctocolectomy and IPAA should have lifelong surveillance.

Conflicts Of Interest

The authors have no conflicts of interest to declare.

References

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