Columnar cuff cancer after restorative proctocolectomy for familial adenomatous polyposis

Aims-Restorative proctocolectomy with ileoanal anastomosis is one of the tr eatments of choice for patients suffering from familial adenomatous polypos is (FAP). However, any residual rectal mucosa left behind after mucosectomy is at risk for the development of neoplasia. Case report-A 31 year old male patient with FAP underwent restorative proct ocolectomy with a pelvic ileal pouch-anal anastomosis. Seven years later he presented with right inguinal and perianal pain. A diagnosis of invasive c olumnar cuff carcinoma was made. Discussion-Islets of columnar epithelium may be left behind after restorati ve proctocolectomy, exposing the patient to later malignant change. This ri sk must be emphasised and prevented by regular surveillance of the anastomo sis.