The surgical and anatomical basis for using the colon as a substitute for the esophagus were established in 1911 by Kelling and Vuillet1 and for many years was the technique of choice for esophageal replacement2. Its use is helpful in benign diseases, such as caustic or peptic strictures, and malignancies1 , 3, especially when the stomach cannot be used, and also in children with congenital anomalies2 , 4. However, this procedure is subject to early complications, as ischemia of the colon and leakage5, or late problems as anastomosis stenosis, ischemic colitis, fistula due to diverticulitis and malignant lesions4.
The transposed colon cancer is a rare complication. Since 2007, six new cases were reported and two reviews published. Hwang et al6 found 10 reported cases of adenocarcinoma in the transposed colon and Bando et al7 also reviewed 10 cases in the literature, encompassing adenomas and adenocarcinomas.
The aim is to report an unique case of synchronous adenocarcinoma of the transposed colon.
Woman with 53-years-old diagnosed with congenital esophageal atresia, underwent to several surgical procedures in childhood, the latest was a cervical retrosternal esophagocoloplasty at 11 years old. After 42 years she was evolved with cervical dysphagia, and an initial diagnosis of stenosis of the esophagocolic anastomosis was performed, treated with endoscopic dilation without improvement. Later, biopsies were performed in the area of stenosis in proximal colonic segment (Figure 1) and polypectomy of sessile polyp of 10 mm, 5 cm distal to the stenosis (Figure 2). The pathological assessment showed tubular-villous intramucosal adenocarcinoma at the resected polyp and the area of stenosis was a invasive adenocarcinoma in colonic mucosa. Colonoscopy of remained colon was normal. Staging performed with CT scan showed an eccentric wall thickening of proximal colon transposed with luminal reduction target of left innominate vein; densification of mediastinal fat plane adjacent and regional lymph nodes up to 1.9 cm.
Developed by Surya MKT