Recurrent adenocarcinoma developed in an ileal conduit in a 75-year-old man who had undergone cystectomy and ileal conduit diversion for adenocarcinoma of the bladder 16 months before. The excised tumor was histologically identical to the original bladder tumor, and the mucosa of the ileal conduit was not involved by the tumor. Multiple lung metastases preceded the development of the recurrent tumor. The recurrent adenocarcinoma in the ileal conduit seemed to be a manifestation of a generalized spread of the tumor.