A 65-year-old male patient smokes 20 cigarettes per day with a history of duodenal ulcer.
She had been operated 5 years previously for a stenosing neoplasm of the rectosigmoid junction (Dukes stage B adenocarcinoma, T3N0M0, stage III-A AJCC), performing an anterior stapler resection.
The postoperative period of this intervention was uneventful and the patient was followed up in the outpatient clinic every 6 months, performing annually and ultrasound.
Endoscopic imaging of the perianastomotic region was normal in all reviews, including the last one, performed the previous year (at 4 years after surgery).
Five years after the intervention, the patient began with soft stools, intermittent abdominal pain in the hypogastrium and later with positive rectal bleeding. The patient was admitted to the internal medicine department with an anal stenosis ending with a pathological CT scan.
Biopsy is performed in which there are no histopathological signs of malignant disease and is reported as nonspecific ulcer.
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Since serum tumor markers were normal, and in the absence of other signs of neoplasia, it was decided to repeat endoscopy and perform an opaque enema.
The new endoscopy and biopsy showed identical findings to previous ones.
In the opaque enema, irregular colon stenosis of 8 cm in length was observed, and the possibility of malignant stenosis could not be ruled out with this image.
To complete the lack of diagnostic tests for tumour recurrence, we decided a period of treatment with corticoid enemas (budesonide, 2 mg enema, 2 times a day) in order to reduce inflammation endoscopically.
1.
After one month, with the asymptomatic patient, the endoscopy was repeated, finding an ulcerated and mucosa, covered with a 6-8 cm long stenosis. Inflammatory signs of the rest of the colon were already observed. The colon was normal.
Biopsies taken showed nonspecific inflammatory signs.
The stenosis is judged to be of ischemic origin and, given that the patient is totally asymptomatic, a periodic follow-up is decided.
At 6 months of follow-up, electrocardiographic changes were detected, and the cardiologist was consulted.
By ergometry and coronary angiography irregularities were found in the middle proximal anterior descending, severe involvement of the ostium of the diagonal branch, 80% stenosis of the marginal obtuse branch and 80% stenosis in the middle right coronary artery.
Dilatation and implantation of a double coronary stent were decided, after which the electrocardiographic changes disappeared.
After 16 months of follow-up, the patient has normal transit and is asymptomatic.
