Repeated Anastomotic Recurrence After Right Hemicolectomy: A Rare Therapeutic Challenge

Rabti Souphia¹, Ben Hassine Basma¹, Wael Ferjaoui², Ben Marzouk Sawssen³, Lassad Gharbi⁴, Saadia Bouraoui⁴, Dhouha Bacha⁵

Keywords: Colon neoplasms, colectomy, surgical anastomosis, neoplasm recurrence, local, treatment outcome

DOI: 10.63475/yjm.v4i3.0219

DOI URL: https://doi.org/10.63475/yjm.v4i3.0219

Publish Date: 31-12-2025

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Pages: 648 - 652

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Author Affiliation:

1 Resident, Department of General Surgery, Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, Tunis, Tunisia
2 Associate Professor, Department of General Surgery, Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, Tunis, Tunisia
3 Assistant Professor, Department of General Surgery, Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, Tunis, Tunisia
4 Professor of Pathology, Department of Pathology, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunis, Tunisia
5 Associate Professor, Department of Pathology, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunis, Tunisia

Abstract

Anastomotic recurrence after curative resection of colorectal cancer represents a rare but clinically significant phenomenon, occurring in approximately 2% of operated patients. We present a case report of a 61-year-old male patient who developed two successive anastomotic recurrences after right hemicolectomy with ileocolic anastomosis for mucinous adenocarcinoma. The patient initially underwent right hemicolectomy in 2016 for T4b, N2b, M0 mucinous adenocarcinoma with clear surgical margins. Following completion of adjuvant chemotherapy, the first anastomotic recurrence occurred in January 2019 (36 months postoperatively), treated by ileocolic resection with ileocolic anastomosis. The second recurrence occurred in March 2020 (14 months after the first recurrence), managed by total colectomy with ileorectal anastomosis. Pathological examination confirmed recurrence with characteristics similar to the primary tumor in both instances. At 3 months follow-up after the final intervention, no additional recurrence was observed. Repeated anastomotic recurrence represents a rare therapeutic challenge requiring intensive surveillance, a multidisciplinary approach, and escalating surgical management. Understanding pathophysiological mechanisms, including the role of the anastomotic microenvironment and tumor biology, is important for developing preventive strategies in highrisk patients.

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