Abstract
Colon cancer which represents a long segmental stenosis and has a cobblestone-like appearance is generally likely to be indistinguishable from inflammatory bowel disease. We treated two such cases in a 30-year-old woman and a 48-year-old man. The woman had a previous history of ulcerative colitis; she suffered from peritonitis due to a perforation of the sigmoid colon and underwent a simple closure of the perforation, a transverse colostomy and drainage. An enema performed after the operation showed a long segmental stenosis and fistula formation between the colon and ileum. Diagnosed as having inflammatory bowel disease, probably Crohn's disease, she was treated with conservative therapy. However, further examinations revealed the existence of colon cancer. The man was admitted to our hospital for melena. An enema and colonoscopy revealed a long segmental stenosis and the cobblestone appearance of the transverse colon. Diagnosed as having inflammatory bowel disease, probably Crohn's disease, he was treated with conservative therapy. However, his condition did not improve in spite of therapy. Tumor marker analysis showed an increased CEA level. A colonoscopy was performed again and revealed the existence of colon cancer. In both patients, the cancer was far advanced. They both underwent a segmented resection of the colon, and both died in spite of chemotherapy.
The morphology of stenosis of inflammatory bowel disease is said to be smooth with tapering edges which gradually fuse into the nonstenotic bowel. However, as was the case with these patients, it is not always easy to distinguish stenosis of inflammatory bowel disease from cancer, especially when it coexists with a cobblestone appearance. Therefore, a careful examination and the suspicion of malignancy is essential in cases like this.
