The perioperative management of the patient with pemphigus vulgaris and villous adenoma.

A focal adenocarcinoma in a rectal villous adenoma occurred in a patient with pemphigus vulgaris. The dermatologic, surgical, and anesthetic aspects of the patient's management required special consideration. A gastrostomy was performed and the rectal carcinoma was removed surgically by low anterior colon resection with end-to-end anastomosis. Because of the patient's pemphigus lesions, epidural anesthesia augmented by intravenous ketamine was administered to avoid airway instrumentation. Supplemental oxygen during surgery was delivered by nasal cannula. Therapy with oral prednisone was begun two weeks postoperatively.