Adenocarcinoma in an ano-vaginal fistula in Crohn's disease

INTRODUCTION: Fistulas are a relatively common occurrence in Crohn's disease (CD), and often present early in the disease process. Additionally, patients suffering from either CD or ulcerative colitis are shown to have an increased risk of colorectal malignancies compared with the general population. PRESENTATION OF CASE: We present a case of adenocarcinoma in an ano-vaginal fistula in a patient with longstanding CD. DISCUSSION: Various pathogenic mechanisms for the development of carcinoma in fistulas have been suggested, but there is no consensus and indeed this risk may be cumulative. In this case report, we also discuss the pathogenesis of mucinous adenocarcinoma in fistulas secondary to CD. CONCLUSION: Better detection of adenocarcinoma in patients presenting with persistent non-resolving fistulas in the presence of CD should be undertaken with regular biopsies following examinations under anaesthetic of the anorectum. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.