Abstract
A 54-year-old man without particular family and disease histories visited our facility for the first time with the chief complaints of constipation and abdominal flatulence. We diagnosed his condition as ileus associated with a sigmoid colon tumor on the basis of findings from plain abdominal computed tomography. He underwent emergency lower gastrointestinal endoscopy and a metallic stent was inserted through the anus. After the stent insertion, defecation and intestinal decompression were achieved. Subsequently, barium enema study performed after adequate pretreatment revealed a tumor about 4 cm in diameter affecting the ileocecum and the transverse colon. We attempted to observe the stent from the oral side endoscopically, but it was impossible to insert the endoscope at that point. The patient was diagnosed before the operation with multiple colon tumors, and underwent subtotal resection of the large bowel. Histopathological examination revealed synchronous multiple cancers (eight lesions in total), including a lesion pSS at the stenosed site of the sigmoid colon, six lesions located in the colon proximal to the stenosed site and one rectal lesion for which preoperative endoscopic mucosal resection had been performed.
When dealing with obstruction of the left colon, endoscopic transanal stent insertion is useful in maintaining the quality of life of patients as well as in gaining detailed evaluation of the oral segments of the intestine. When dealing with patients suspected of colorectal cancer, a detailed preoperative examination of the oral segments of intestine is desirable because of possible presence of multiple colon tumors.
