A Case of Complete Anastomotic Membranous Obstruction That Developed after Surgery for Sigmoid Colon Cancer with Bladder Invasion

Abstract

A 68-year-old man had been diagnosed with sigmoid colon cancer at age 65, but ceased medical attention on his own initiative. Two years later, he was hospitalized for colonic ileus. Abdominal CT showed no distant metastasis, but indicated massive tumor invasion into the bladder. Chemotherapy was started after transverse colostomy. The therapy caused the tumor and infiltrating lesion to shrink, and laparoscopic sigmoidectomy and partial resection of the bladder were performed. The bowel was reconstructed using a double stapling technique with an automated anastomosis device, and there were no postoperative complications. Six months of adjuvant chemotherapy was added due to the pathological diagnosis of ypStage IIa. Without any recurrence or metastasis, colostomy closure was scheduled, but a preoperative examination showed complete obstruction at the anastomosis. Although the ring shape of the anastomosis was preserved, mucosa had developed in the lumen, resulting in a membranous obstruction. The center of the obstruction was cauterized and balloon dilation was performed under endoscopic observation from both sides of the anus and the colostomy. Two days later, colostomy closure was performed. We report this case as a rare example of complete membranous obstruction of an anastomosis.