Colon and anorectal neoplasms in a tropical African population

At the University College Hospital, Ibadan, Nigeria, over a 30-month period (January 1975 to June 1977) more than 29 cases were fully studied. Nine patients presented with acute large bowel obstruction. In five cases, colonic neoplasms were palpated abdominally before surgery, and four of the patients were initially being treated for "hemorrhoids". All the patients presented at late stages. There was neither socio-economic nor sexual bias in this affliction. Sixty-nine percent of all the tumors occurred in the anorectal area well within the reach of the index finger, and 27.5% occurred in the right colon. Differential diagnosis included ameboma, rectal schistosomiasis, rectal tubercolosis, anal fistula and adult chronic intermittent intussusception. The treatment administered depended on the nature, location and stage of the disease. There was a case of metastatic squamous cell carcinoma of the hepatic flexure causing obstruction. The metastasis was from carcinoma of the cervix which had been treated with cesium insertions about three years previously. It is now known that colon and anorectal neoplasms, once regarded as rare among Africans living in tropical Africa, is not that rare. With the Africans boycotting native "doctors" in favor of medical institutions, many of the diseases once thought to be rare in Africans will unfortunately become less rare.