ANASTOMOTIC SITE CARCINOMA IN A PATIENT ON URETEROSIGMOIDOSTOMY AFTER 2 DECADES. IMPORTANCE OF SCREENING RE-EMPHASIZED

Colonic carcinoma arising from the site of a functioning ureterosigmoidostomy anastomosis is a recognized late complication .This article reports one such case and re-emphasizes on the value of screening following ureterosigmoidostomy.A 27 year old male a known case of Exstrophy Epispadias complex for which he has undergone Ureterosigmoidostomy and excision of the bladder at the age of 1 year completely lost followup.He presented with right loin pain and fever for the past 1 month. CT scan of the KUB region showed a right hydroureteronephrosis and a growth in the site of Ureterosigmoidostomy. Sigmoidoscopy showed a proliferative growth in the ureterosigmoidostomy site which on biopsy was reported as adenocarcinoma. The patient underwent right nephroureterectomy and sigmoidectomy. The left ureter was brought out through an ileal conduit.Patients with ureterointestinal anastomosis need periodic screening to rule out malignancy at the anastomotic site. The incidence is 100- 550 times that of the general population .Hence all patients should have a flexible sigmoidoscopy once per year, commencing atleast 10 years after surgery.