A Case of Multiple Carcinoma of the Rectum Complicating Ulcerative Colitis

We encountered a case of multiple cancer of the rectum complicating ulcerative colitis. The patient was a 29-year-old woman who had been treated medically since the age of 17 years for repeated episodes of ulcerative pancolitis. Upon deterioration involving bloody stools and tenesmus, she was diagnosed as having rectal cancer by endoscopic biopsy. Total coloproctectomy was performed by the abdomino-perineal approach, and an ileal fistula was constructed. The resected specimen showed mucosal disruption and atrophy of the entire colon, moderately differentiated adenocarcinoma of the invasive ulceration type in the rectum, and cauliflower-shaped well differentiated adenocarcinoma in the rectosigmoid colon. Several elevated lesions showing adenomatous change were observed on the proximal side of the cancer and at the splenic curvature. Cancer complicating ulcerative colitis is still uncommon in Japan, but its incidence is expected to increase as ulcerative colitis is followed up for a longer period. Periodic examination is required for early detection of this condition, and endoscopy for evaluating changes in atypical epithelium is of particular importance.