Adenocarcinoma arising in "J" pouch after total proctocolectomy for familial polyposis coli

A patient of familial adenomatous polyposis (FAP) without extra intestinal lesions is presented. The patient underwent a proctocolectomy with J pouch ileal reservoir with an ileoanal anastomosis. The clinical course was further complicated by an adenocarcinoma developing in the J pouch. This was excised totally and a terminal illeostomy was constructed. The aim of doing a prophylactic proctocolectomy in familial polyposis coli is to prevent a malignancy developing and to restore function with an illeoanal pouch. However polyps can occur in the gastric, duodenal and intestinal mucosa, which can lead to malignancy. Greater awareness and close follow up is needed even after prophylactic proctocolectomy.