Considerations for diagnosis and management of ileostomy-related malignancy: a report of two cases

Malignancy associated with a long-standing ileostomy is a rare occurrence reported as early as 3 years after ileostomy placement. Patients most commonly present first to their ostomy care nurse with peristomal skin changes unresponsive to conservative measures. To elucidate presentation and management, two cases of male patients with ileostomy-related with malignancy (one lymphoma and one squamous cell carcinoma) are discussed. Both patients had undergone proctocolectomy with end ileostomy decades prior. Symptoms in the lymphoma patient included complaints of skin irritation, stoma mucosa changes and friability, and a persistent rash around the ostomy; he was found to have small bowel friability and a peristomal mass arising from the terminal ileum that was resected en bloc with the ileostomy, the surrounding skin, and associated abdominal wall musculature. The patient with squamous cell carcinoma had developed a gray-tan skin lesion around his ileostomy site; he underwent exploratory laparotomy with wide local excision of the abdominal wall including ileostomy site, distal ileum, and squamous cell carcinoma, and resiting of the ileostomy to the contralateral abdominal wall. Ostomy care providers should be aware of the clinical presentation of ostomy-associated malignancy to ensure thorough evaluation and prompt referral for surgical management are provided.