Hidefumi Tsushima

A CASE OF EARLY COLORECTAL CANCER PRESENTING WITH MASSIVE MELENA

An 88-year-old man was urgently admitted to the hospital because of massive melena on September 27 1991. Emergency colonoscopy revealed a polyp of Yamadas type III in the sigmoid colon, but no definite bleeding site was determined. Ultrasonography and CT showed bilateral common iliac aneurysms which were not thought the bleeding source. Hemorrhagic scintigraphy for exploration of bleeding site led to a diagnosis that it was located in a portion of the sigmoid colon. On October 1 sigmoidectomy and colostomy were performed. A 10×8mm Yamadas type III polyp was found in the sigmoid colon and clots adhered to its surface. So it was determined that the bleeding stemmed from the polyp. Histopathologically the polyp was carcinoma in adenoma with invasion depth of m, with an artery locating in shallow layer of sm which appeared the bleeding vessel. It is very rare that massive hemorrhage breaks out from a small carcinoma in adenoma with a diameter of less than one cm, and is also interesting that hemorrhagic scintigraphy greatly contrubutes to determine the bleeding site. This paper describes such a rare and interesting case with a review of the literature.