A 79-year-old man presented with a massive subcutaneous swelling due to extreme dilatation ofa subcutaneously interposed right-sided hemicolon; 7 years earlier he had undergone oesophageal resection and gastric tube reconstruction for a poorly differentiated adenocarcinoma of the distal oesophagus. The procedure was complicated by gastric tube necrosis, and the tube was removed. One year later the continuity of the gastrointestinal tract was restored by a right-sided isoperistaltic colon graft: the terminal ileum, including the ileocecal valve, was anastomosed to the pre-existing cervical portion of the oesophagus. The dilatation was caused by an obstructive adenocarcinoma located in the distal part of the interposed colon in combination with an intact ileocecal valve in the neck. The tumour was a primary colon carcinoma with no evidence of further dissemination. The colon graft was removed, and the patient received a definitive salivary fistula placed in the neck and permanent feeding tube by jejunostomy. Development of primary colon carcinoma in a colon graft is rare; 7 cases have been reported in the literature so far. Routine endoscopic follow-up of a graft does not appear to be warranted, but endoscopy should be performed if symptoms arise.