Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis.
BACKGROUND
Colorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required.


METHODS
The case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free.


CONCLUSIONS
Removal of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer.


CONCLUSIONS
Eversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.
Division of General Surgery, Hospital de Base, Porto Velho City, Brazil. Electronic address: roriz-silva@unir.br.
Renato
R
Roriz-Silva
Division of General Surgery, Hospital de Base, Porto Velho City, Brazil.
Alexei Almeida
AA
Andrade
Division of General Surgery, Hospital de Base, Porto Velho City, Brazil.
Ivan Gregório
IG
Ivankovics
Adenoma villous; Operative; Rectal neoplasms; Surgical procedures