The association of Crohn's disease and cancer is uncommon, with an overall prevalence of 0.45% . Carcinoma in Crohn's disease is associated with strictures, extensive disease and onset of the disease before the age of 30 years. Sandmeier reported 3 patients with cancer in Crohn's disease from a database of 661 patients between 1993 and 2001; only one patient had a rectal localisation (signet ring cell variant) 4 years after a subtotal colectomy with ileosig-moid anastomosis .
Connell et al. , in a review on 2500 patients with Crohn's disease from 1940 to 1992, described 15 patients who developed a carcinoma of the lower gastrointestinal tract. Thirteen patients had a cancer in the upper third of the rectum (one), in the lower third of the rectum (seven) and in the anus (five patients). Patients with a cancer arising in the rectum had long-standing severe anorectal disease with a stricture in four, a fistula in four, a proctitis in one and an abscess in two patients.
Nikias et al.  reviewed the medical records of 16 patients with simultaneous diagnosis of Crohn's disease and carcinoma with eight rectal lesions of which two developed cancer in a defunctionalised rectum. Six patients had severe anorectal disease.
Instead of a low rate of incidence of rectal cancer, in young patients with long-standing, severe ano-rectal Crohn's disease, the fate of the rectum should be considered.
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