Necrobiotic granulomas of the bowel accompanying 3-year postsurgical recurrence of colon cancer: A case report

INTRODUCTION: Postsurgical necrobiotic granulomas present a diagnostic challenge and have been described in organs such as the urinary bladder, prostate, and uterus. However, occurrence of these granulomas is rare in the bowel. PRESENTATION OF THE CASE: In this report, we present the case of a 28-year-old woman with recurrent multifocal colonic adenocarcinoma 3 years after sigmoidectomy. Intraoperatively, the ileum was suspicious for tumor deposits. Total colectomy with segmental small bowel resection was performed, and the histopathological findings of the small bowel specimen were consistent with necrobiotic granulomas with no evidence of malignancy. Infectious disease workup was negative. The patient was administered adjuvant chemotherapy and had no negative outcomes at 8 months after the surgery. DISCUSSION: This is a rare and challenging case of postsurgical necrobiotic granulomas of the bowel. CONCLUSION: Granulomas with “active” necrobiosis can occur as late as 3 years after colon cancer surgery and can be a diagnostic pitfall that significantly affects the management.