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Carpeted villous adenomas of rectum may be extensive and not suitable for transanal excision or Endoscopic mucosal resection. We present a case of such lesion extending from anorectal junction to rectosigmoid region. After biopsy and staging, this was managed by a sphincter saving procedure, i.e. a combination of transabdominal total mesorectal excision and transanal intersphincteric dissection, with acceptable functional outcome with 8 years of follow up.
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