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Case Reports
. 2020 Jul;35(7):1337-1341.
doi: 10.1007/s00384-020-03569-z. Epub 2020 Mar 17.

Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn's disease-a unique case report

Denis Ehrl  1 , Markus Rentsch  2 , Nicholas Moellhoff  1 , Nikolaus Wachtel  3
Affiliations
Case Reports

Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn's disease-a unique case report

Denis Ehrl et al. Int J Colorectal Dis. 2020 Jul.

Erratum in

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory disorder which leads to anorectal fistulas. In rare cases, patients develop anal squamous cell carcinoma (ASCC) within these lesions. There is limited literature regarding ASCC in patients with CD. Here, we report on a unique case of advanced verrucous carcinoma (VC), a rare variant of squamous cell carcinoma, developing on the grounds of extensive chronic anorectal fistulas in CD.

Methods and results: A 54-year-old male patient with a 20-year history of CD presented with a large inflammatory tumor at the perineal region with multiple discharging perianal fistulas. Histopathological analysis of the perineal mass revealed a VC. Subsequent surgery with radical tumor resection and terminal colostomy resulted in a large perineal cavity and a partially exposed sacrum. The defect extended to a total of 35 × 25 × 25 cm. Reconstruction was achieved through a two-step approach. A first surgical step established an arteriovenous (AV) loop in the upper thigh. Subsequently, a free latissimus dorsi (LD) myocutaneous flap was harvested and anastomosed with the AV loop, allowing for satisfactory closure of the defect and reconstruction of the perianal and perineal region.

Conclusion: Radical surgical excision with negative margins is the therapy of choice for VC. This case report demonstrates a curative treatment option with special emphasis on the reconstructive possibilities of a unique case of extended perianal and perineal VC associated with chronic anorectal fistulas in CD.

Keywords: Crohn’s disease; Verrucous carcinoma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Extensive inflammatory perineal tumor with multiple perianal fistulas (20 × 10 cm)
Fig. 2
Fig. 2
CT scan of the perineal and perianal region showing multiple abscesses (marked by an asterisk)
Fig. 3
Fig. 3
Abdominoperineal resection and excision of the perineal tumor resulted in a wound with a cavity of approximately 35 × 25 × 25 cm
Fig. 4
Fig. 4
Fistula (AV loop) between the great saphenous vein and the lateral circumflex femoral artery (marked by an asterisk)
Fig. 5
Fig. 5
Intraoperative view with free latissimus dorsi myocutaneous flap inserted to reconstruct the perineal defect, the muscular part of the flap was covered with split-thickness skin grafts
Fig. 6
Fig. 6
Result 7 weeks postoperatively
See this image and copyright information in PMC

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