Lucky Local Recurrence

Abstract

In February 1976 the patient underwent a curative resection of a moderately well differentiated adenocarcinoma of the lower third of the sigmoid colon. The vascular ligation was immediately below the upper left colic artery. The distal margin of the tumor clearance was 5cm. A 2-layer anastomosis was performed which was later measured at 13cm from the anus. At operation, the uterus was noted to be enlarged and retroverted with a large fibroid on the upper part of the posterior surface. The carcinoma involved 2/3 of the lumen for a distance of 45mm and “partly infiltrated” the muscularis propria. One mesenteric lymph node 2cm from the colon contained adenocarcinoma, 12 other lymph nodes were negative (Dukes C, T₂ N₁ M₀). One year after operation, clinical examination and examination under anesthetic revealed a mass in the “pouch of Douglas” (PD), attached to the uterus and the wall of the bowel at the level of the anastomosis. Investigations for metastatic disease elsewhere were negative. [Computerized tomography (CT) and transrectal ultrasound (TRUS) assessment of the pelvis were not available for this patient in 1976].