Abstract
A patient with adenomatous polyposis coli (APC) without extraintestinal lesions is presented. The clinical course was complicated by rectal adenocarcinoma following subtotal colectomy. A primary adenocar-cinoma arising in a villous adenoma within the ileostomy stoma developed seven years later. The varied pathology of gastric and small intestinal involvement in APC/Gardner's syndrome is reviewed. Greater awareness of these lesions has implications for further management.