C. B. Williams, BM, MRCP·

CASE REPORT A 55-year-old man in 1967 underwent total cystectomy and insertion of both ureters into the sigmoid colon for widespread carcinoma of the bladder. Postoper­ atively he developed a sigmoid colon perforation and required re-insertion of the left ureter into the descending colon. In 1975 a hydronephrotic left kidney was diagnosed. In 1977 episodes of rectal bleeding commenced. Sig­ moidoscopy to 20 cm was normal, and barium enema radiography was reported as normal. The Fujinon FC-QBF instrument was introduced to the proximal transverse co­ lon. There was a 5-cm irregular, friable polypoid lesion with superficial exudate in the descending colon, the mac­ roscopic appearance suggesting a malignant polyp (Figure 1). The lesion was snared and removed without immediate hemorrhage or pain.