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Session: ePoster: Colon and Colorectal Cancer 12 (Mon1015)

EP694 - Adenocarcinoma Arising in a Chronic Anal Fistula: A Case Series

Monday, May 12, 2025
10:20 AM – 10:25 AM PT

    ePoster Presenter(s)

  • LR

    Lynnsey M. Rebner, DO

    Resident Physician
    Bayhealth GME
    Dover, DE, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • HM

    Hamdan Mallick, MD

    Resident Physician
    Bayhealth Medical Inc
    Dover, Delaware, United States

    Disclosure information not submitted.

  • AJ

    Amber Jacobson, DO

    Resident Physician
    Bayhealth Medical Inc
    Dover, Delaware, United States

    Disclosure information not submitted.

  • AF

    Adrianne Fisher, MSN, FNP-BC

    Nurse Practitioner
    Bayhealth Medical Center
    Dover, Delaware, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • AR

    Assar Rather, MD, FACS

    Colorectal Surgeon
    Bayhealth Medical Inc
    Dover, Delaware, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • BK

    Barath Krishnan, MD, FACS

    Surgeon
    Bayhealth Medical Inc
    Dover, Delaware, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Lynnsey M. Rebner, DO: This individual has no financial relationships with ineligible companies.
Assar Rather, MD, FACS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Perianal fistula associated with adenocarcinoma is a rare occurrence, with only a few cases reported in the literature. Abdominoperineal resection (APR) is the well-established standard of care for surgical management, however, there is neither a screening process nor a standardized approach for adjuvant therapy.

Methods/Interventions: We report a case series of three patients diagnosed with adenocarcinoma arising in chronic anal fistula at our institution.

Results/Outcomes: Two of the three patients had a long-standing history of perianal Crohn’s disease lasting at least 15 years, and the third patient had a chronic anal fistula for approximately 4 years, but no personal or family history of inflammatory bowel disease. Two of the three patients underwent APR while the third needed diverting colostomy and total neoadjuvant therapy. One of our patients developed metastatic disease and transitioned to palliative chemotherapy.

Conclusion/Discussion: While adenocarcinoma arising from chronic fistulas is rare, there should still be a high index of suspicion in patients with non-healing chronic fistulas with and without a diagnosis of IBD. Our case series highlights the importance of careful monitoring while demonstrating a unique association that has not been described. Screening may be necessary in cases with high-risk features; however, a larger study must be conducted to delineate these high-risk features and who may benefit from screening or ongoing surveillance.