Brown-bowel-syndrome: Association with an adenocarcinoma of the ascending colon

We describe the case of an 82-year-old man in whom a hemicolectomy was carr ied out to treat adenocarcinoma of the ascending colon. The histopathologic al examination of the resected segment of the colon revealed a moderately-w ell differentiated adenocarcinoma with infiltration of the surrounding adip ose tissue (pT3, G2, Stage III, Dukes C2). In addition, a "brown-bowel-synd rome" with discrete lipofuscin deposition in the muscularis propria of the ascending colon was found, the small bowel was not involved - nor was the v ascular muscle. Postoperative determination of vitamin E in the peripheral blood revealed vitamin E deficiency (2 mu m/ml). Neither preoperatively nor following or during postoperative adjuvant low-dose chemotherapy did the p atient suffer from either constipation or diarrhoea. Six months after oral vitamin E replacement treatment, the vitamin E levels in peripheral blood w ere back to normal. Since our patient did not have a malabsorption syndrome , the aetiology of the vitamin E deficiency remains unclear. Deposits of lipofuscin in the presence of vitamin E deficiency points to no n-function of the body's redux system. Inadequate oxidation of unsaturated fatty acids and an increase in free oxygen radicals favour the development of gastrointestinal tumours. Further studies are needed to investigate more closely the role of deposited lipofuscin and old age, with particular atte ntion being paid to coincident gastrointestinal tumours. Currently, treatme nt is symptomatic (vitamin E).