PMC7332502_01
Fungating mass of colostomy. Gross appearance of colostomy mass at time of biopsy. Initial biopsies revealed tubulo-villous adenoma with foci of high-grade dysplasia but were equivocal for invasive carcinoma.
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On her left abdomen, her colostomy was noted to have a tender, fungating mass involving more than 50% of its circumference (Fig. 1).
Computed tomography (CT) image of abdomen and pelvis with fungating mass involving colostomy. Axial (A) and sagittal (B) images of suspected colonic malignancy at left lower quadrant colostomy. Red arrows indicate the fungating mass at the colostomy site.
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CT scan of the abdomen and pelvis detected soft issue fullness along the anterior intra-abdominal margin of the colostomy and mild colon wall thickening, but no evidence of nodal enlargement or metastatic disease (Fig. 2).
Complex anatomy on CT. This patient had a history of multiple congenital abnormalities (imperforate anus, bladder exstrophy and spina bifida) requiring numerous abdominal and pelvic procedures during childhood. Demonstrated on coronal imaging (A) is the patient's short stature (127 cm), urostomy site (yellow arrow) and colostomy with fungating mass (red arrow). Her severe lumbosacral kyphosis is better appreciated on sagittal imaging (B).
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Specific issues of concern included the patient's short stature and kyphosis, prior incision sites and urostomy location, prior left chest irradiation and the expected sizable defect at the colostomy site (Fig. 3, Fig. 4).
Post-operative images. Immediate (A) and post-operative day 56 (B).
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A Brooke ileostomy was created using 3-0 Ethicon Chromic Suture  (Fig. 5).